Regional Anesthesia and Pain Medicine最新文献

{"title":"Impact of opioid-free general anesthesia with locoregional blocks during breast cancer surgery on systemic inflammatory response: results from a randomized controlled trial.","authors":"Fabrizio Brescia, Andrea Favero, Ilenia Segatto, Samuele Massarut, Chiara Zanier, Fabio Fabiani, Elisa Nadalini, Antonietta Morabito, Marcella Montico, Antonella Zucchetto, Stefania Zanussi, Gustavo Baldassarre, Barbara Belletti","doi":"10.1136/rapm-2025-106504","DOIUrl":"10.1136/rapm-2025-106504","url":null,"abstract":"<p><strong>Background: </strong>For breast cancer patients with localized disease, surgery remains a cornerstone of treatment. Anesthesia during surgery is essential for pain management and influences patient recovery. Opioid-free general anesthesia with locoregional blocks (OfGA), as an alternative to traditional opioid-based general anesthesia (GA), may improve patient outcomes.</p><p><strong>Methods: </strong>We set up a randomized trial to compare the impact of different anesthetic approaches on post surgical inflammation in breast cancer patients undergoing quadrantectomy. Patients were randomized to receive GA (n=34) or OfGA (n=34). Blood samples were collected pre-surgery and 1 hour and 24 hours post-surgery. As primary endpoint, neutrophil-to-lymphocyte ratio (NLR) was calculated. As secondary endpoints we collected data on side effects, pain management, and circulating inflammatory cytokines.</p><p><strong>Results: </strong>Patients of the GA arm displayed significantly increased NLR, both at 1 (median change +0.13, IQR 0.01 to 0.62, p<0.0001) and 24 (median change +0.64, IQR 0.28 to 1.03, p<0.0001) hours post-surgery, compared with baseline. On the contrary, the OfGA arm displayed stable or minimally increased NLR (median change -0.08, IQR -0.21 to 0.17, p=ns, at 1 hour; +0.11, IQR -0.11 to 0.36, p=ns, at 24 hours post-surgery). Circulating inflammatory cytokines aligned with NLR data, showing significant increases in key inflammatory factors in samples from the GA arm compared with the OfGA arm. Pain management was similar in both arms, but OfGA was better tolerated and elicited fewer side effects.</p><p><strong>Conclusions: </strong>In breast cancer surgery, opioid-free general anesthesia combined with locoregional blocks was associated with a reduced postoperative inflammatory response compared with conventional opioid-based general anesthesia, without compromising pain control. Further research is needed to determine whether these biological effects translate into meaningful clinical outcomes.</p><p><strong>Trial registration number: </strong>NCT04172220.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"1151-1160"},"PeriodicalIF":4.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499340","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":"SPACE-Postpartum: a multidomain biopsychosocial framework for predicting chronic pain and impaired recovery after cesarean delivery - proof-of-concept report.","authors":"Sarah Ciechanowicz, Daqing Ma","doi":"10.1136/rapm-2025-107149","DOIUrl":"10.1136/rapm-2025-107149","url":null,"abstract":"<p><strong>Background: </strong>Chronic postsurgical pain after cesarean delivery affects 15%-17% of women and impairs maternal recovery, yet existing prediction models predominantly rely on demographic or procedural factors, with acute pain intensity a key but limited predictor. Symptom cluster research in chronic pain populations has consistently identified co-occurring domains in sleep, pain, affect, cognition, and energy (SPACE) that may represent a modifiable risk phenotype.</p><p><strong>Methods: </strong>The SPACE-Postpartum framework was conceptualized through triangulation of qualitative interviews with postpartum individuals experiencing persistent pain, exploratory analyses from a prospective cohort study, and existing literature on symptom clusters in chronic pain. The resulting multidomain model was operationalized into a prototype tool and subsequently evaluated for proof-of-concept feasibility within the same cohort of women following cesarean delivery.</p><p><strong>Results: </strong>Qualitative data confirmed the salience of all five SPACE domains in women's recovery narratives. In the cohort, exploratory analyses supported the feasibility of applying the prototype tool for early multidomain risk stratification. Early symptom profiles consistent with SPACE domains were also identified using latent class methods and were associated with chronic pain intensity and interference, reinforcing the framework's coherence.</p><p><strong>Conclusions: </strong>SPACE-Postpartum represents an early operationalization of a multidomain, symptom-based biopsychosocial framework for postpartum recovery after cesarean delivery. Developed from converging qualitative, observational, and literature evidence and tested at the proof-of-concept level, it provides a patient-centered foundation for future validation studies. Larger and more diverse cohorts are needed to establish predictive performance and clinical utility.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"1197-1202"},"PeriodicalIF":4.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145369316","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":"When clinical trials do not go as planned.","authors":"Brian D Sites","doi":"10.1136/rapm-2026-108527","DOIUrl":"10.1136/rapm-2026-108527","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"1111"},"PeriodicalIF":4.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945491","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":"Combining micro-endoscopy and ultrasound guidance for transversus abdominal plane catheter insertion: a feasibility cadaveric study.","authors":"Augustin Schaefer, Thomas Bessede, Dan Benhamou, Laura Ruscio","doi":"10.1136/rapm-2026-107967","DOIUrl":"https://doi.org/10.1136/rapm-2026-107967","url":null,"abstract":"<p><strong>Background and objectives: </strong>Continuous transversus abdominis plane could represent a valid alternative for postoperative analgesia after open abdominal surgery. Unfortunately, placing catheters along the transversus abdominis plane is challenging even with ultrasound guidance. Coupling conventional ultrasound guidance with direct vision via micro-endoscopy could potentially improve visualization of the tissue plane and reduce unintended intramuscular catheter placement and intramuscular infusion.</p><p><strong>Methods: </strong>After institutional approval, transversus abdominis plane catheters were placed in anatomical bodies under combined ultrasound guidance and micro-endoscopic vision. After colored dye injection through the catheters, anatomical dissection was performed to objectively determine spread.</p><p><strong>Results: </strong>Four catheters showed a successful intended-plane dye spread into transversus abdominis plane in three anatomical bodies. For all catheters, adjunction of micro-endoscopic vision was needed to obtain catheter progression along the transversus abdominis plane. Successfully spread covered T8 to T12 segmental levels.</p><p><strong>Conclusions: </strong>This preliminary cadaveric study suggests that correct positioning of catheters into the transversus abdominis plane could be facilitated by micro-endoscopy vision coupled with ultrasound guidance. Additional studies are needed to confirm these results.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118617","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":"Analgesia for minimally invasive thoracic surgery: comparing thoracic paravertebral to erector spinae plane block-a retrospective single-center study.","authors":"Victor Polshin, Ben L P Braeuer, Theresa Tenge, Max N Hentges, Guanqing Chen, Béla-Simon Paschold, Carsten Marcus, Liana Zucco, Andrey Rakalin, Sebastian D Sahli, Sidhu P Gangadharan, Jennifer L Wilson, Luca J Wachtendorf, Maximilian S Schaefer","doi":"10.1136/rapm-2026-108183","DOIUrl":"https://doi.org/10.1136/rapm-2026-108183","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive thoracic surgery (MITS) has become the primary approach for the vast majority of thoracic surgeries, facilitating improved recovery. Still, control of postoperative pain is challenging, which can substantially threaten recovery. Prophylactic thoracic paravertebral block (TPVB) is a common approach to facilitate analgesia after MITS. Recently, erector spinae plane block (ESPB) has been widely employed as a technically easier alternative. It is still unclear which technique is associated with lower postoperative opioid administration and faster recovery.</p><p><strong>Methods: </strong>In this analysis utilizing hospital registry data, patients who underwent MITS and received either TPVB or ESPB at Beth Israel Deaconess Medical Center between 2020 and 2024 were eligible for inclusion. We excluded patients with American Society of Anesthesiologists (ASA) physical status classification>IV, patients with known pregnancy, and patients undergoing trauma surgery or procedures in addition to one-sided MITS. The primary outcome was opioid consumption in the postanesthesia care unit (PACU), assessed by cumulative oral morphine equivalents (OME). Secondary outcomes included the time to first opioid administration, PACU length of stay (LOS), and hospital LOS. Multivariable negative binomial regression analysis was applied, adjusting for patient and procedural characteristics.</p><p><strong>Results: </strong>A total of 404 patients were included in the final study cohort (283 ESPB and 121 TPVB), receiving a median (IQR) of 25.5 mg OME (15.0-42.5) in the PACU. After adjustment, patients receiving TPVB required 9.4 mg less OME (95% CI -15.7 to -3.0, p<0.01) when compared with ESPB. The predicted time to first opioid administration was 11.4 min shorter for TPVB (95% CI 1.3 to 21.5, p=0.03). Adjusted analyses revealed a 118 min shorter LOS in the PACU (95% CI -216 to -20, p=0.02) and 1.2 fewer days in the hospital (95% CI -1.6 to -0.7, p<0.001) for patients receiving TPVB.</p><p><strong>Conclusions: </strong>TPVB compared with ESPB for MITS was associated with decreased opioid use in PACU and shorter PACU and hospital LOS. These findings provide a rationale for prospective trials to investigate factors contributing to enhanced postoperative recovery with TPVB as compared with ESPB.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118639","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":"Assessing the changes in outcome measurements in randomized controlled trials of regional anesthesia interventions: a registry-publication comparison study.","authors":"Caitlin McCormick, Danielle Waller, Ryan Langerman, Tag Harris, Kellen Keefer, Rachel Hazlitt, Logan Corwin, Ahmed Elghzali, Alicia I Ford, Matt Vassar","doi":"10.1136/rapm-2026-108295","DOIUrl":"https://doi.org/10.1136/rapm-2026-108295","url":null,"abstract":"<p><strong>Background: </strong>Regional anesthesia (RA) is increasingly used due to its safety and effectiveness in reducing postoperative pain and opioid use. As in other areas of clinical research, transparent and consistent outcome reporting is important for interpreting trial evidence. This study assessed the extent and nature of temporal changes to prespecified outcomes in interventional RA trials registered on ClinicalTrials.gov after the implementation of the Final Rule and the Food and Drug Administration Amendments Act 801.</p><p><strong>Methods: </strong>We conducted a registry-based cross-sectional analysis of RA trials initiated between January 2017 and December 2024. Eligible trials enrolled adults, were interventional in design, had posted tabular results on ClinicalTrials.gov, and were linked to a peer-reviewed publication. Using ClinicalTrials.gov version histories, we compared the earliest and most recent registry records to identify modifications in outcome definitions, timing and classifications. Changes were categorized by type, timing and interpretive impact. Disclosure of modifications in registry records and publications was assessed.</p><p><strong>Results: </strong>Among 74 eligible trials, 91.9% exhibited at least one substantive outcome change between registry versions. Among trials with substantive outcome modifications, the most recently entered substantive modification occurred after primary completion in 47.1% and after publication in 51.5%, and none were disclosed. Changes to both primary and secondary outcomes were common, with 37.8% of trials exhibiting high-impact modifications. Minor rewording was the most frequent change type, though often accompanied by more substantive shifts in outcome measurement tools, timepoints, or classifications. Secondary outcomes were more frequently added or removed than primary outcomes.</p><p><strong>Discussion: </strong>In this sample of 74 RA trials, differences between the earliest and most recent registered outcome fields were common, including changes involving primary outcomes. For most of these trials, the most recently entered substantive modification occurred after primary completion or publication and was not explicitly explained in the associated publication. These findings describe the frequency and timing of registry modifications but cannot determine why the changes occurred or whether they influenced the reported results.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082694","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: New persistent opioid use: a case for defining the problem.","authors":"Stephan Frangakis, Scott J Keating, Konrad Pisarczyk, Jan Tuzil, Ann M Menzie","doi":"10.1136/rapm-2026-108427","DOIUrl":"https://doi.org/10.1136/rapm-2026-108427","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149066128","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":"Crystal precipitates of local anaesthetic and adjuvant mixtures can be visualised and graded using ultrahigh-frequency ultrasound imaging.","authors":"Anna Seisl, Lukas Gasteiger, Ottokar Stundner, Elisabeth Skalla, Hannes Gruber, Helmut Oberherber, Elisabeth Gasteiger","doi":"10.1136/rapm-2026-108294","DOIUrl":"https://doi.org/10.1136/rapm-2026-108294","url":null,"abstract":"<p><strong>Background: </strong>The use of mixtures of local anaesthetics and/or adjuvants is a common practice in regional anaesthesia, aimed at optimising onset time and prolonging block duration. However, several previous in vitro studies have demonstrated that mixing local anaesthetics may lead to crystallisation. A major barrier to understanding their potential physiological effects has been the lack of imaging techniques capable of detecting crystal formations beyond conventional microscopy.</p><p><strong>Methods: </strong>In this in vitro study, ropivacaine 0.75%, lidocaine 2%, chloroprocaine 2% and mepivacaine 2%, as well as six commonly used local anaesthetic or local anaesthetic-adjuvant mixtures, were imaged by high-resolution ultrasound in liquid medium, using two high-resolution probes of 24 MHz and 33 MHz over a maximum duration of 40 min. The sonographic grade of crystallization was assessed on a scale from 0 to 3 based on the number and size of visible precipitates.</p><p><strong>Results: </strong>Two pure local anaesthetics-lidocaine and chloroprocaine-demonstrated minimal crystallization. All mixtures produced precipitates immediately after mixing, with mild to moderate increases in crystallization quantities over time. The mixture of ropivacaine, lidocaine, and sodium bicarbonate exhibited the highest tendency to crystallise, reaching a sonographic grade of crystallization of 1 at baseline, increasing to 3 at 20-40 min.</p><p><strong>Conclusion: </strong>All investigated mixtures demonstrated precipitation detectable by high-resolution ultrasound; the combination of ropivacaine, lidocaine and sodium bicarbonate showed the most pronounced effect. Ultrasound imaging proved to be a suitable method for detecting and grading crystalline structures in vitro and may represent a possible technology for future in vivo diagnostics.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041922","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":"Frequency and timing of a subsequent opioid use disorder diagnosis in surgical patients prescribed postoperative opioids at 90-180 days after surgery.","authors":"Brian H Park, Sophia A Scandurro, Megan Kawasaki, Brittany Nicole Burton, Rodney A Gabriel","doi":"10.1136/rapm-2026-108293","DOIUrl":"https://doi.org/10.1136/rapm-2026-108293","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041874","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":"Asymptomatic intrathecal baclofen pump catheter failure discovered during routine reservoir replacement: a case report.","authors":"Heeho Kim, Priyanka Singla","doi":"10.1136/rapm-2026-108277","DOIUrl":"https://doi.org/10.1136/rapm-2026-108277","url":null,"abstract":"<p><strong>Background: </strong>Intrathecal baclofen (ITB) therapy effectively manages severe spasticity. While mechanical complications typically cause therapy loss or withdrawal, structural disruptions can remain completely occult due to anatomical adaptations. This report explores the unique management of an incidentally discovered catheter transection during routine reservoir exchange.</p><p><strong>Case presentation: </strong>A female patient in her 30s with cerebral palsy had been treated with ITB since 2011 without functional complaint, despite sluggish cerebrospinal fluid (CSF) flow noted at a 2019 pump exchange that did not prompt catheter revision. After relocating out of state, the patient returned in 2025 for a planned pump reservoir replacement, reporting no interval decline. Preoperative catheter port myelography was not successful due to failure of CSF aspiration from the catheter access port, and intraoperative exploration revealed the catheter was completely fractured at its fascial insertion point, despite the reported years of clinical stability. Fragment retrieval required partial laminectomy and multilayer dural repair; after new hardware placement and retitration, her therapeutic outcome improved dramatically.</p><p><strong>Conclusions: </strong>Subjective clinical efficacy is an unreliable proxy for system patency. Aging hardware configurations require proactive radiographic monitoring and targeted surgical revision to minimize the risk of withdrawal.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149032050","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}