Regional Anesthesia and Pain Medicine最新文献

{"title":"Reply to Goyal and colleagues.","authors":"Eric S Schwenk, Polina Ferd","doi":"10.1136/rapm-2024-105635","DOIUrl":"10.1136/rapm-2024-105635","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"454"},"PeriodicalIF":5.1,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141184981","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":"Effect of virtual reality hypnosis on intraoperative sedation needs and functional recovery in knee arthroplasty: a prospective randomized clinical trial.","authors":"Michele Carella, Florian Beck, Caroline Quoilin, Murielle M Azongmo, Adrien Loheac, Vincent L Bonhomme, Audrey Vanhaudenhuyse","doi":"10.1136/rapm-2023-105261","DOIUrl":"10.1136/rapm-2023-105261","url":null,"abstract":"<p><strong>Background and objectives: </strong>Perioperative psychological stress and pharmacological anxiolysis can negatively affect the quality of recovery after total knee arthroplasty. We aimed to assess whether hypnosis combined with virtual reality could reduce intraoperative pharmacological sedation and improve quality of recovery after total knee arthroplasty surgery.</p><p><strong>Methods: </strong>In this prospective randomized clinical trial, 60 patients scheduled for total knee arthroplasty with spinal anesthesia were randomly divided into 2 groups of 30 patients each. Intraoperatively, intermittent boluses of midazolam 1 mg were administered at 5 min intervals at the patient's request, with a maximum driven by the clinical assessment of sedation depth. During surgery, patients received standard care (group control) or virtual reality hypnosis (group VRH). An unblinded observer recorded the total dose of midazolam administered during surgery, and changes in the Quality-of-Recovery 15-item score, comfort, fatigue, pain and anxiety before and 1, 3 and 7 days after surgery.</p><p><strong>Results: </strong>Patients in the VRH group required a lower dose of midazolam (mg; median (range)) intraoperatively (group VRH: 0 (0-4) and group control: 2 (0-9), p<0.001). Quality-of-Recovery 15-item, anxiety, and pain were similar between groups.</p><p><strong>Conclusions: </strong>In total knee arthroplasty with spinal anesthesia, VRH reduces the requirement for intraoperative pharmacological sedation, without a change in the quality of recovery.</p><p><strong>Trial registration number: </strong>NCT05707234.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"383-389"},"PeriodicalIF":5.1,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139984581","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":"Multimodal pain management and postoperative outcomes in inpatient and outpatient shoulder arthroplasties: a population-based study.","authors":"Helen Liu, Haoyan Zhong, Nicole Zubizarreta, Paul Cagle, Jiabin Liu, Jashvant Poeran, Stavros G Memtsoudis","doi":"10.1136/rapm-2023-104984","DOIUrl":"10.1136/rapm-2023-104984","url":null,"abstract":"<p><strong>Introduction: </strong>Multimodal analgesia has been associated with reduced opioid utilization, opioid-related complications, and improved recovery in various orthopedic surgeries; however, large sample size data is lacking for shoulder surgery.</p><p><strong>Methods: </strong>A retrospective review using the Premier Healthcare Database of patients who underwent inpatient or outpatient (reverse, total, partial) shoulder arthroplasty from 2010 to 2019. Opioid-only analgesia was compared with multimodal analgesia, categorized into 1, 2, or >2 additional analgesic modes, with/without a nerve block. Multivariable regression models measured associations between multimodal analgesia and opioid charges (in oral morphine equivalents (OME)), cost and length of stay, and opioid-related adverse effects (approximated by naloxone use). We report % change and 95% CIs.</p><p><strong>Results: </strong>Among 176 225 procedures, 169 679 (75.7% multimodal analgesia use) and 6546 (37.8% multimodal analgesia use) were inpatient and outpatient shoulder arthroplasties, respectively. Among inpatients, multimodal analgesia (>2 modes) without a nerve block (vs opioid-only analgesia) was associated with adjusted reductions in OMEs on postoperative day 1: -19.4% (95% CI -21.2% to -17.6%/representing unadjusted median OME reductions from 45 to 30 mg). For total hospitalization, this was -6.0% (95% CI -7.2% to -4.9%/representing unadjusted median OME reductions from 173 to 135 mg). Conversely, for outpatients, this was +13.7% change in OMEs (95% CI +4.4% to +23.0%/representing unadjusted median OME increases from 110 to 131 mg). In both settings, addition of a nerve block to multimodal analgesia attenuated effects in terms of opioid charges.</p><p><strong>Conclusions: </strong>Multimodal analgesia is associated with reductions in opioid charges-specifically inpatient setting-but not various other outcomes.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"390-401"},"PeriodicalIF":5.1,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140159531","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":"Intravenous versus oral acetaminophen for postoperative pain in ambulatory spine surgery: letter to the editor.","authors":"Nitika Goyal, Kapil Soni, Riniki Sarma","doi":"10.1136/rapm-2024-105581","DOIUrl":"10.1136/rapm-2024-105581","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"453-454"},"PeriodicalIF":5.1,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140900241","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":"Fluoroscopy-guided high-intensity focused ultrasound ablation of the lumbar medial branch nerves: dose escalation study and comparison with radiofrequency ablation in a porcine model.","authors":"Michael Gofeld, Thomas Tiennot, Eric Miller, Niv Rebhun, Stephen Mobley, Suzanne Leblang, Ron Aginsky, Arik Hananel, Jean-Francois Aubry","doi":"10.1136/rapm-2024-105417","DOIUrl":"10.1136/rapm-2024-105417","url":null,"abstract":"<p><strong>Background: </strong>Radiofrequency ablation (RFA) is a common method for alleviating chronic back pain by targeting and ablating of facet joint sensory nerves. High-intensity focused ultrasound (HIFU) is an emerging, non-invasive, image-guided technology capable of providing thermal tissue ablation. While HIFU shows promise as a potentially superior option for ablating sensory nerves, its efficacy needs validation and comparison with existing methods.</p><p><strong>Methods: </strong>Nine adult pigs underwent fluoroscopy-guided HIFU ablation of eight lumbar medial branch nerves, with varying acoustic energy levels: 1000 (N=3), 1500 (N=3), or 2000 (N=3) joules (J). An additional three animals underwent standard RFA (two 90 s long lesions at 80°C) of the same eight nerves. Following 2 days of neurobehavioral observation, all 12 animals were sacrificed. The targeted tissue was excised and subjected to macropathology and micropathology, with a primary focus on the medial branch nerves.</p><p><strong>Results: </strong>The percentage of ablated nerves with HIFU was 71%, 86%, and 96% for 1000 J, 1500 J, and 2000 J, respectively. In contrast, RFA achieved a 50% ablation rate. No significant adverse events occurred during the procedure or follow-up period.</p><p><strong>Conclusions: </strong>These findings suggest that HIFU may be more effective than RFA in inducing thermal necrosis of the nerve.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"429-436"},"PeriodicalIF":5.1,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12128762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177742","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":"Correction: Years of potential life lost from COVID-19 and the opioid crisis in 2020-2021 in Northern New England.","authors":"","doi":"10.1136/rapm-2023-104430.corr1","DOIUrl":"https://doi.org/10.1136/rapm-2023-104430.corr1","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":"50 5","pages":"e1"},"PeriodicalIF":5.1,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012389","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":"No evidence of fascicular injury following a low-volume intraneural injection of the median nerve: a cadaveric study.","authors":"Jorge Mejia, Pierre Goffin, Miguel A Reina, Xavier Sala-Blanch","doi":"10.1136/rapm-2024-105294","DOIUrl":"10.1136/rapm-2024-105294","url":null,"abstract":"<p><strong>Background: </strong>The test dose or hydrolocation technique allows rapid detection of spread location. Though its primary aim is to enhance safety in peripheral nerve blocks, evidence on the potential risks of an intraneural test aliquot is lacking. We conducted a cadaveric study to evaluate the risk of fascicular injury following a low-volume (<1 mL) intraneural injection of the median nerve.</p><p><strong>Methods: </strong>Ten upper limbs from fresh unembalmed human cadavers were studied. In-plane ultrasound-guided intraneural injections of the median nerve were performed at mid, proximal, and distal locations using 1 mL of methylene blue and heparinized blood solution. Nerves were extracted and samples immersed in 10% buffered formalin for 4 weeks. Perpendicular 3 mm slices were obtained for H&E staining and light microscopy analysis. Our main objective was to assess the number of injured fascicles. Secondarily, we evaluated the pattern of intraneural spread. Fascicular injury was defined as the presence perineurium or axonal disruption and/or the presence of erythrocytes inside a nerve fascicle.</p><p><strong>Results: </strong>Thirty injections were performed in 10 median nerves. Sonographic swelling was confirmed in 100% of the cases. 352 histological sections were analyzed to assess study outcomes. The mean number of fascicles on each section of median nerve was 20±6 covering 49%±7% of the nerve area. No evidence of axonal disruption nor intra-fascicular erythrocytes was found in any of the analyzed sections.</p><p><strong>Conclusions: </strong>Low-volume intraneural injections do not result in evident fascicular injury. Our findings support the use of a test dose in ultrasound-guided regional anesthesia.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"417-420"},"PeriodicalIF":5.1,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139991814","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":"Low-dose ketamine infusion to facilitate opioid tapering in chronic non-cancer pain with opioid-use disorder: a historical cohort study.","authors":"Antoine Elyn, Anne Roussin, Cécile Lestrade, Nicolas Franchitto, Bénédicte Jullian, Nathalie Cantagrel","doi":"10.1136/rapm-2023-105035","DOIUrl":"10.1136/rapm-2023-105035","url":null,"abstract":"<p><strong>Background: </strong>Long-term opioid use is associated with pharmacological tolerance, a risk of misuse and hyperalgesia in patients with chronic pain (CP). Tapering is challenging in this context, particularly with comorbid opioid-use disorder (OUD). The antihyperalgesic effect of ketamine, through N-methyl-D-aspartate (NMDA) antagonism, could be useful. We aimed to describe the changes in the dose of opioids consumed over 1 year after a 5-day hospitalisation with ketamine infusion for CP patients with OUD.</p><p><strong>Methods: </strong>We performed a historical cohort study using a medical chart from 1 January 2014 to 31 December 2019. Patients were long-term opioid users with OUD and CP, followed by the Pain Center of the University Hospital of Toulouse, for which outpatient progressive tapering failed. Ketamine was administered at a low dose to initiate tapering during a 5-day hospitalisation.</p><p><strong>Results: </strong>59 patients were included, with 64% of them female and a mean age of 48±10 years old. The most frequent CP aetiologies were back pain (53%) and fibromyalgia (17%). The baseline opioid daily dose was 207 mg (±128) morphine milligram equivalent (MME). It was lowered to 92±72 mg MME at discharge (p<0.001), 99±77 mg at 3 months (p<0.001) and 103±106 mg at 12 months. More than 50% tapering was achieved immediately for 40 patients (68%), with immediate cessation for seven patients (12%). 17 patients were lost to follow-up.</p><p><strong>Conclusions: </strong>A 5-day hospitalisation with a low-dose ketamine infusion appeared useful to facilitate opioid tapering in long-term opioid users with CP and OUD. Ketamine was well tolerated, and patients did not present significant withdrawal symptoms. Prospective and comparative studies are needed to confirm our findings.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"421-428"},"PeriodicalIF":5.1,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12128771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140159530","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":"Addressing barriers to the implementation of an Acute Pain Service rib fracture pathway: effect on quality and outcomes of care for trauma patients.","authors":"Shalini Shankla, Daniel I McIsaac, Pooja Balani, Jacinthe Lampron, Cecilia Bu, Ian Zunder, Sarah Tierney","doi":"10.1136/rapm-2024-106326","DOIUrl":"https://doi.org/10.1136/rapm-2024-106326","url":null,"abstract":"<p><strong>Introduction: </strong>Successful clinical pathway implementation requires effectively addressing barriers to delivery prior to pathway introduction, and critical evaluation of impact post-delivery. We aimed to assess whether the implementation of an Acute Pain Service pathway, designed to address barriers identified prior to introduction, influenced the delivery of regional analgesia to high-risk rib fracture patients or was associated with changes in secondary clinical outcomes (respiratory complications, delirium, mortality, length of stay, and pain scores) and processes (Acute Pain Service consults, timely provision of regional analgesia, and use of non-regional analgesic modalities).</p><p><strong>Methods: </strong>A quality improvement project was conducted and evaluated using retrospective observational data at a tertiary care trauma center between July 2018 and June 2023. System and process interventions were made to address potential hurdles to effective pathway implementation. Pre-pathway and post-pathway delivery of regional analgesia (truncal block or epidural) to patients with Rib Fracture Scores ≥6 was assessed using run charts, as well as statistically with pre-post comparisons.</p><p><strong>Results: </strong>After pathway implementation, the use of regional analgesia increased from 16.4% to 19.7%, with run charts demonstrating a meaningful shift near the end of the study period; pre-post comparisons did not suggest a statistically significant change (p=0.195). Acute Pain Service consult rates increased from 46.7% to 49.6% (p=0.37).</p><p><strong>Discussion: </strong>The implementation of an Acute Pain Service rib fracture analgesic pathway at a tertiary care trauma center did not substantially increase the proportion of patients who received a regional catheter for analgesia or lead to improvements in clinical outcomes. Further addressing structural aspects of care and refining patient selection criteria may be necessary to achieve better outcomes.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011883","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":"Fluoroscopy-guided suprazygomatic approach to pterygopalatine fossa block: a brief technical report.","authors":"Pedro Hilton de Andrade Filho, Camila Lobo Ferreira, João Fernando Paulichenco Mantoan, Charles Amaral de Oliveira, Fabricio Dias Assis, Miles Day","doi":"10.1136/rapm-2024-106323","DOIUrl":"https://doi.org/10.1136/rapm-2024-106323","url":null,"abstract":"<p><strong>Background: </strong>The pterygopalatine fossa (PPF) is a compartment with rich autonomic and somatic innervation of the head, making it a crucial target for pain management interventions. Among the various techniques described, the suprazygomatic approach to the PPF may be one of the safest. However, the application of fluoroscopy to guide this approach has not been previously reported.</p><p><strong>Methods: </strong>To the best of our knowledge, this is the first report in the literature describing a fluoroscopy-guided suprazygomatic approach to the PPF block. This brief technical report provides a step-by-step description of the technique and presents five cases demonstrating its implementation.</p><p><strong>Results: </strong>Five cases were successfully performed using the fluoroscopy-guided suprazygomatic approach for the management of primary and secondary headache disorders. The findings demonstrate that the technique is feasible, safe, and effective.</p><p><strong>Conclusions: </strong>The fluoroscopy-guided suprazygomatic approach to the PPF offers a viable alternative to traditional methods and deserves further consideration in clinical practice.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999629","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}