Regional Anesthesia and Pain Medicine最新文献

{"title":"Anatomic basis of the PENG block: dissection, cryocross-sections, and histology challenge a pericapsular target by Gautier <i>et al</i>.","authors":"Joanna Tomlinson, Laura Girón-Arango, Philip Peng","doi":"10.1136/rapm-2026-108474","DOIUrl":"https://doi.org/10.1136/rapm-2026-108474","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026444","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":"Real-time AI-assisted nerve tracking for ultrasound-guided nerve identification: a prospective randomized trial.","authors":"Jeongsoo Kim, Seung Pyo Nam, Jehyuk Yoo, Yoontae Hong, Hungjun Joo, Yongjae Yoo, Jee Youn Moon","doi":"10.1136/rapm-2026-108180","DOIUrl":"https://doi.org/10.1136/rapm-2026-108180","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI)-assisted nerve tracking facilitates real-time ultrasound-guided nerve identification, but its effect on independent nerve identification after AI support is removed remains uncertain.</p><p><strong>Methods: </strong>In this prospective randomized trial, 80 ultrasound novices (60 medical students and 20 anesthesiology residents) were assigned to either a control group receiving B-mode ultrasound training without AI assistance or an AI-assisted group using a real-time nerve tracking system (NerveTrack). Following a standardized lecture and a 10-minute hands-on training session, participants underwent assessment with the AI function disabled. The primary outcome was first-attempt independent identification success for the median nerve and supraclavicular brachial plexus. Secondary outcomes included performance after additional training and self-reported confidence.</p><p><strong>Results: </strong>78 participants completed the study. First-attempt independent identification success rates did not differ significantly between the control and AI-assisted groups for the median nerve (57.5% vs 65.8%; RR 1.14, 95% CI 0.81 to 1.62; p=0.452) or the brachial plexus (35.0% vs 42.1%; RR 1.20, 95% CI 0.68 to 2.11; p=0.519). Following additional AI-assisted training, participants in the AI-assisted group reported greater confidence in identifying the brachial plexus than those in the control group (4.7±0.5 vs 4.4±0.9; p=0.046). No significant differences were observed in independent identification success after additional training.</p><p><strong>Conclusions: </strong>Brief AI-assisted training did not improve immediate independent ultrasound identification of the median nerve or supraclavicular brachial plexus after AI support was removed. These findings do not establish long-term retention, transfer to unfamiliar anatomy, or clinical procedural performance.</p><p><strong>The registration number: </strong>NCT05857787.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002892","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":"Transcutaneous auricular vagus nerve stimulation to prevent rebound pain after interscalene block for arthroscopic shoulder surgery.","authors":"Jun Zhang, Shumin Lu, Shaojie Lin, Lijuan Yang, Ping Zhao, Jiaqi Qian, Shunshu Xu, Qiuwan Han, Nuan Li","doi":"10.1136/rapm-2026-108256","DOIUrl":"https://doi.org/10.1136/rapm-2026-108256","url":null,"abstract":"<p><strong>Background: </strong>Rebound pain frequently occurs after resolution of single-shot interscalene brachial plexus block (ISB) and may diminish the overall analgesic benefit of regional anesthesia. Transcutaneous auricular vagus nerve stimulation (taVNS) has demonstrated analgesic and anti-inflammatory properties, but its effect on rebound pain after shoulder arthroscopy remains unclear.</p><p><strong>Methods: </strong>In this single-center, randomized, participant- and assessor-blinded, sham-controlled trial, 120 adults undergoing elective arthroscopic shoulder surgery with ultrasound-guided single-shot ISB were randomized 1:1 to receive either active taVNS or sham stimulation. Active stimulation was applied perioperatively and continued on postoperative days 1 and 2. The primary outcome was the incidence of rebound pain within 24 hours after surgery. Secondary outcomes included postoperative pain scores, cumulative sufentanil consumption, quality of recovery (QoR-15), sleep quality (Richards-Campbell Sleep Questionnaire), and adverse events.</p><p><strong>Results: </strong>One hundred twenty participants completed the study and were included in the intention-to-treat analysis. Rebound pain occurred in 12 of 60 patients (20.0%) assigned to taVNS compared with 26 of 60 patients (43.3%) assigned to sham stimulation (absolute risk reduction 23.3%, 95% CI 7.2% to 39.5%; number needed to treat 4.3, 95% CI 2.5 to 13.9; relative risk 0.46, 95% CI 0.26 to 0.82; p=0.006). taVNS was associated with lower resting pain scores (mean difference -0.50, 95% CI -0.63 to -0.37; p<0.001) and movement-evoked pain scores (mean difference -0.39, 95% CI -0.65 to -0.14; p=0.003). Patients receiving taVNS demonstrated higher QoR-15 scores on postoperative days 1 and 2 and better sleep quality on the night of surgery and postoperative night 1 (all p<0.01). The between-group difference in cumulative sufentanil consumption was not statistically significant (GMR 0.67, 95% CI 0.44 to 1.01; p=0.056). No stimulation-related adverse events were observed.</p><p><strong>Conclusions: </strong>Perioperative taVNS may reduce the incidence of rebound pain following single-shot ISB in patients undergoing arthroscopic shoulder surgery. taVNS was also associated with modest reductions in pain scores and improvements in quality of recovery and sleep quality without an increase in adverse events.</p><p><strong>Trial registration number: </strong>ChiCTR2500107694.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978743","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 percutaneous temporary vagus nerve stimulation for refractory post-traumatic chronic pain and post-traumatic stress disorder (PTSD): first reported case and implantation technique.","authors":"Hesham Elsharkawy, Amara Breanne Ajon, Karim Elsharkawy, Faria Nisar","doi":"10.1136/rapm-2026-108153","DOIUrl":"https://doi.org/10.1136/rapm-2026-108153","url":null,"abstract":"<p><strong>Background: </strong>Post-traumatic stress disorder (PTSD) and chronic pain frequently coexist and are often refractory to conventional therapies. Vagus nerve stimulation (VNS) has emerged as a potential neuromodulatory approach targeting autonomic dysregulation and central pain pathways. VNS has traditionally been delivered using either transcutaneous approaches or surgical implantation; however, to the best of our knowledge, ultrasound-guided percutaneous peripheral nerve stimulation targeting the vagus nerve has not previously been described.</p><p><strong>Case report: </strong>We present the case of a female in her late 20s with refractory chronic pain syndrome, PTSD, post-traumatic headaches, and occipital neuralgia following multiple traumatic brain injuries sustained during domestic violence. After failing conservative management, the patient underwent ultrasound-guided percutaneous implantation of a left vagus nerve peripheral nerve stimulator for 60 days and demonstrated remarkable improvement. Over an 8-week period of temporary implantation, pain scores decreased from 10/10 to 0/10, with concomitant resolution of gastrointestinal symptoms, fatigue, and PTSD symptoms. Analgesic improvement was sustained at 4-month follow-up, while PTSD symptom scores measured using the PTSD Checklist for DSM-5 (PCL-5) increased during the same time interval. Because a baseline pre-procedure PCL-5 score was not available, the overall magnitude of change relative to the patient's pretreatment status cannot be determined despite PTSD symptom scores increasing during follow-up.</p><p><strong>Conclusions: </strong>We present the use of the 60-day percutaneous temporary implantation of VNS for PTSD and chronic post-traumatic pain, along with a detailed description of the ultrasound-guided implantation technique.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945161","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":"Psychological evaluation before neuromodulation: not just a gatekeeper.","authors":"Ravi Prasad, Naileshni Singh, Scott Pritzlaff","doi":"10.1136/rapm-2026-108156","DOIUrl":"https://doi.org/10.1136/rapm-2026-108156","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944929","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":"Evaluation of a mental health screening tool to determine the need for psychological interview for patients offered neuromodulation implant therapies for pain.","authors":"Maggie Z X Xiao, Kathryn Curtis, Abigail Muere, Hemkumar Pushparaj, Victoria Bains, Yasmine Hoydonckx, Pranab Kumar, Ehtesham Baig, Abeer Alomari, Ryan S D'Souza, Anuj Bhatia","doi":"10.1136/rapm-2025-107507","DOIUrl":"10.1136/rapm-2025-107507","url":null,"abstract":"<p><strong>Introduction: </strong>Psychological comorbidities can negatively impact outcomes of spinal cord stimulation (SCS) for chronic pain. While psychological assessment is commonly required before SCS implantation, evidence supporting its impact on outcomes is limited, and such assessments may be unnecessary for many patients and contribute to delays in care. Our center implemented a screening tool incorporating validated questionnaires and a mental health checklist to triage the need for formal psychological evaluation. This prospective, observational cohort study compared outcomes of SCS trials and implants between patients who bypassed (fast track: FT) versus those who underwent a formal assessment by a psychologist (AP).</p><p><strong>Methods: </strong>Data were collected from patients undergoing SCS trials between July 2017 and December 2021. The screening tool used thresholds on validated questionnaires assessing anxiety, depression, catastrophizing, and opioid misuse risk, along with a checklist capturing significant anxiety or depression, self-harm, substance abuse, or mental-health-related hospitalization. Patients screening positive underwent an AP; others proceeded directly to trial (FT). 1 year post implantation outcomes were collected, with successful implantation defined as ≥30% pain reduction from baseline.</p><p><strong>Results: </strong>Of 171 patients (114 AP, 57 FT), trial-to-implant rates were similar (72% AP vs 70% FT, p=0.811). The proportion of responders at 1 year post implant was also comparable (53% AP vs 60% FT, p=0.927). Multivariate logistic regression identified that higher baseline pain intensity (adjusted OR (aOR) 0.70, 95% CI 0.53 to 0.92, p=0.011) and use of tricyclic antidepressants (aOR 0.15, 95% CI 0.04 to 0.56, p=0.005) were associated with implant failure, whereas pain duration >10 years was associated with implant success (aOR 3.09, 95% CI 1.06 to 9.02, p=0.039).</p><p><strong>Conclusions: </strong>This screening tool effectively identifies patients who can bypass routine psychological assessment without compromising 1 year SCS outcomes. Implementation can streamline patient flow, reduce wait times, and reserve psychological resources for those who need formal evaluation.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147357467","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":"Beyond research geography: interpreting global inequity in spinal cord stimulation.","authors":"Tuhin Mistry, Samarjit Dey","doi":"10.1136/rapm-2026-108471","DOIUrl":"https://doi.org/10.1136/rapm-2026-108471","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946297","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":"Historical perspective on evolution of neuraxial delivery for pain (1975-2025).","authors":"Tony Yaksh, Salim Michel Hayek","doi":"10.1136/rapm-2026-108095","DOIUrl":"https://doi.org/10.1136/rapm-2026-108095","url":null,"abstract":"<p><p>In the present commentary, we consider the historical trajectory that reflects the evolution of neuraxial therapeutics that has transpired over the last 50 or so years, with a particular emphasis on its application to pain and its management. The review addresses the advances that led to where we are now in the 21st century with neuraxially targeted therapeutics and consideration of where this thread leads.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":"51 9","pages":"1012-1027"},"PeriodicalIF":4.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148913432","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":"Implanted intrathecal pump catheter migration rates in the management of cancer-related pain.","authors":"Gabriel Andres Martinez Alvarez, Shane E Brogan, Daniel W Odell, Jill E Sindt","doi":"10.1136/rapm-2025-106866","DOIUrl":"https://doi.org/10.1136/rapm-2025-106866","url":null,"abstract":"<p><strong>Introduction: </strong>Intrathecal drug delivery systems offer a potent modality for managing cancer-related pain that is resistant to conservative measures. However, catheter-related complications, particularly migration, remain a concern. This study assessed the prevalence, risk factors, and implications of catheter migration rates in patients with intrathecal pumps (ITP) for cancer-related pain.</p><p><strong>Materials and methods: </strong>A retrospective database and chart review of 441 patients with cancer with an ITP at the Huntsman Cancer Institute from May 2014 to December 2023 was performed to identify patients who had two chest CT scans after implant separation by at least 30 days. Catheter migration was defined as movement of the catheter by one or more vertebral levels when comparing the two imaging studies. Demographics were analyzed to identify factors associated with migration. To identify subjects with catheter complications missed by the initial approach, an additional chart review was performed to identify operative procedures linked to catheter revision.</p><p><strong>Results: </strong>117 patients were suitable for analysis, and 15.4% (n=18) had catheter migration between the two CT scans. These were all limited to a single vertebral level. Across the full cohort of 441 patients, radiographically significant migration requiring revision occurred in only two patients (0.45%). No demographic or clinical factors were significantly associated with migration.</p><p><strong>Conclusions: </strong>Minor catheter migration is relatively common following ITP implantation, but clinically significant migration is rare with the anchoring and closure techniques described.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":"51 9","pages":"1028-1033"},"PeriodicalIF":4.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148913885","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":"Practical guide to intrathecal drug delivery: short-term and long-term management and complications.","authors":"Eellan Sivanesan, Florent Bienfait, Yian Chen, Denis Dupoiron, Daniel W Odell, Christophe Perruchoud, Jill E Sindt, Shane E Brogan","doi":"10.1136/rapm-2025-107404","DOIUrl":"https://doi.org/10.1136/rapm-2025-107404","url":null,"abstract":"<p><p>Intrathecal drug delivery (IDD) is an established therapy for patients with refractory pain across cancer and non-cancer populations. By enabling targeted spinal drug delivery, IDD can provide durable symptom control at substantially lower doses than systemic therapy, often reducing systemic medication burden and treatment-limiting adverse effects. Despite decades of clinical experience and supportive evidence, IDD remains underutilized and largely concentrated in high-volume centers, reflecting persistent uncertainty related to patient selection, trialing, device planning, long-term management, limited evidence, and complication mitigation.This practical guide synthesizes current evidence, consensus recommendations, and collective international clinical experience to provide a structured approach to short-term and long-term management of implantable IDD systems. Shared principles applicable across indications are emphasized, while cancer-specific considerations are addressed separately, including prognosis, coordination with oncologic therapies, evolving spinal anatomy, and compressed treatment horizons. Key topics include preimplant evaluation and risk mitigation, trialing strategies and their limitations, pump and catheter selection, perioperative management, early post-implant troubleshooting, long-term maintenance, and surveillance for device-related, biological, and operational complications. Intrathecal pharmacologic strategies for pain are examined, including opioids, local anesthetics, ziconotide, clonidine, and baclofen, with attention to indication-specific dosing, titration, and safety considerations.Clinical outcomes are framed beyond pain intensity alone, emphasizing functional improvement, quality of life, and reduction in systemic medication use as clinically meaningful endpoints. Differences in therapeutic goals, time horizons, and risk tolerance between cancer and non-cancer populations are integrated into a practical decision framework aligned with real-world pain practice. International and regional practice variations are also discussed to contextualize differences in drug availability, compounding practices, and reimbursement. By consolidating pragmatic guidance across the full lifecycle of intrathecal therapy, this guide aims to support consistent, safe, and effective use of IDD for complex pain management in contemporary practice.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":"51 9","pages":"1065-1087"},"PeriodicalIF":4.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914261","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}