Regional Anesthesia and Pain Medicine最新文献

{"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":"https://doi.org/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":""},"PeriodicalIF":5.1,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Driving under the influence of opioids in 2024: a narrative review of science and pandemic policy updates.","authors":"Colin Kirsch, Patrick Wintergalen, Steven P Cohen, Zaman Mirzadeh, S Harrison Farber, Brian G Wilhelmi","doi":"10.1136/rapm-2024-105955","DOIUrl":"https://doi.org/10.1136/rapm-2024-105955","url":null,"abstract":"<p><strong>Background/importance: </strong>Driving under the influence of drugs (DUID) refers to operating a vehicle after consuming drugs or medications other than alcohol that impair the ability to drive safely. There is no consensus on legal limits for drug intoxication while driving in the USA. Balancing the benefits of prescription medications, such as opioids, with traffic safety remains an ongoing public health challenge.</p><p><strong>Objective: </strong>This article examines DUID policy and provides recommendations for policy improvement and unification grounded in scientific evidence on opioid-related impairment and driving risks.</p><p><strong>Evidence review: </strong>A literature review of epidemiologic data, psychomotor effects, and public policy related to opioid use and driving was conducted. A total of 38 epidemiological studies, 21 studies on psychomotor effects, and pertinent laws and policies were reviewed.</p><p><strong>Findings: </strong>Epidemiological data reveal an increasing prevalence of opioid-positive drivers and an association between opioid use and elevated risk of motor vehicle collisions. Psychomotor studies show mixed results, with some indicating impairment in opioid users and others suggesting minimal effects on driving ability. State laws regarding DUID remain heterogeneous, with trends toward expanded testing powers, lower impairment thresholds, and limitations on prescription-based defenses. The lack of standardized opioid testing limits and inconsistent policy approaches across states hinder effective management of opioid-related impaired driving.</p><p><strong>Conclusions: </strong>A balanced public health approach can reduce opioid-involved crashes through education, prevention, enhanced enforcement tools, and rehabilitation. In drafting future DUID laws, policymakers must analyze evolving opioid research when balancing the pain relief of opioids with public roadway safety.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434383","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":"Analysis of complications of minimally invasive approaches for symptomatic lumbar spinal stenosis.","authors":"Nagy Mekhail, Shrif Costandi, Mina Botros, Junaid Mukhdomi, Peter Yassa, Taif Mukhdomi","doi":"10.1136/rapm-2024-105706","DOIUrl":"https://doi.org/10.1136/rapm-2024-105706","url":null,"abstract":"<p><strong>Introduction: </strong>Current treatment modalities of lumbar spinal stenosis range from conservative medical management and physical therapy to open surgical decompression. Minimally invasive lumbar decompression (MILD) and Superion interspinous spacers (SISS) Vertiflex offer the promise of effective pain relief with shorter recovery time and lesser potential complications compared with open surgical decompression procedures and general anesthesia. Despite their increasing utilization, their complication profile is not well established in the literature.</p><p><strong>Methods: </strong>We searched the FDA's Manufacturer and User facility Device Experience (MAUDE) database for all entries on MILD product code 'HRX' and SISS product code 'NQO'. MAUDE database was queried from 2010 to 2021. Duplicate entries were removed, and complications were classified based on the event descriptions.</p><p><strong>Results: </strong>For the MILD procedure, a total of 10 entries were found in the MAUDE database. Among these, 8 were classified as surgical complications and 2 were device related. On the other hand, a total of 919 reports were found in the MAUDE database for Vertiflex, with 385 medical device reports were included in the analysis. Device-related were the most reported complication, accounting for 189 cases.</p><p><strong>Conclusion: </strong>As with any new intervention, we must proceed with caution and evaluate the procedure performance over time. Such data should aid physicians to make informed decisions before choosing either technique for their patients. The findings from this study provide insight into the complication profile associated with both MILD and Vertiflex procedures, highlighting the need for continued evaluation and careful consideration in clinical decision-making.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411467","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":"Primary neuraxial anesthetic for elective total knee arthroplasty in patient with left ventricular assist device.","authors":"Hanin Sheikh, Julia Isabella Klein, Kenneth Elliott Higgins Iii, John W Patton, Benjamin Chu","doi":"10.1136/rapm-2024-106253","DOIUrl":"https://doi.org/10.1136/rapm-2024-106253","url":null,"abstract":"<p><strong>Background: </strong>There is a rising number of patients with left ventricular assist devices (LVADs) undergoing non-cardiac procedures, both emergent and elective. Historically, anesthetic options for these patients have been limited to general anesthesia. Limited data exists for the use of neuraxial anesthesia in patients with LVADs despite its common use in orthopedic procedures for non-LVAD patients. Given the benefits of neuraxial anesthesia and the rising population of LVAD patients undergoing elective procedures, a better understanding of LVAD patients' candidacy for neuraxial anesthesia needs further investigation.</p><p><strong>Case presentation: </strong>We report the case of a patient with an LVAD who successfully underwent a total knee arthroplasty with neuraxial anesthesia at a tertiary academic center. Preoperative transthoracic echo demonstrated stable cardiac function and an ejection fraction of 10-15% with a HeartMate 3 LVAD. The primary anesthetic was a lumbar epidural that was slowly titrated to a surgical anesthetic level and an adductor canal peripheral nerve catheter was placed preoperatively for postoperative analgesia. The patient remained hemodynamically stable throughout the case, with a perfusionist monitoring the LVAD's function intraoperatively, and tolerated the anesthetic well. His postoperative course was uneventful.</p><p><strong>Conclusion: </strong>Patients with LVADs should be considered candidates for neuraxial anesthesia with appropriate preoperative planning and perioperative management.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400524","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":"Response to the letter to the editor.","authors":"Thomas Hickey, Victor Javier Avila-Quintero, Joao P De Aquino","doi":"10.1136/rapm-2025-106481","DOIUrl":"https://doi.org/10.1136/rapm-2025-106481","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392431","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":"Anterior quadratus lumborum block in total hip arthroplasty: a two-center, randomized, placebo-controlled trial showing no additional benefit over multimodal analgesia.","authors":"Romain Rozier, Anouk Loiseleur, Charlotte Ciais, Ophélie Moulin, Baptiste Alais, Kewan Marguerite, Emmanuelle Badia, Laurie Tran, Juliette Balbo, Axel Maurice-Szamburski","doi":"10.1136/rapm-2024-106247","DOIUrl":"https://doi.org/10.1136/rapm-2024-106247","url":null,"abstract":"<p><strong>Background: </strong>Total hip arthroplasty (THA) frequently causes postoperative pain, hindering recovery and prolonging hospital stays. While multimodal analgesia aims to minimize opioid use and enhance outcomes, the optimal regional anesthesia technique is unclear due to the hip's complex innervation.</p><p><strong>Objective: </strong>This multicenter randomized placebo-controlled trial evaluated whether adding an anterior quadratus lumborum block (QLB) to multimodal analgesia with non-steroidal anti-inflammatory drugs (NSAIDs) reduces opioid consumption in THA patients.</p><p><strong>Methods: </strong>60 adults undergoing primary unilateral THA were randomized to receive either anterior QLB with 20 mL of 0.2% ropivacaine (n = 30) or a placebo saline injection (n = 30). All participants received multimodal analgesia including NSAIDs. The primary outcome was cumulative opioid consumption in oral morphine equivalents (OMEs) within the first 24 postoperative hours. Secondary outcomes included patient experience assessed by the EVAN scale on postoperative day 1, elevated pain and opioid consumption on days 1 and 2, time to first standing, walking distance and quadriceps strength on day 1, as well as walking progression, return to sport activity and analgesic use at 3 months.</p><p><strong>Results: </strong>No significant difference was found in 24-hour cumulative OME consumption between groups (median 40 mg (IQR 20-50 mg) vs 31 mg (IQR 20-45 mg); p = 0.6). Patient experience, pain scores and opioid consumption were similar. Rehabilitation outcomes at 3 months also did not differ.</p><p><strong>Conclusion: </strong>Adding anterior QLB to multimodal analgesia did not reduce opioid consumption or enhance postoperative pain control and functional recovery in THA patients. Anterior QLB may not provide additional benefits when combined with multimodal analgesia with NSAID for THA.</p><p><strong>Trial registration number: </strong>NCT04555291.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392427","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":"Understanding regional anesthesia's impact on non-muscle invasive bladder cancer oncological outcomes.","authors":"Eduardo Nunez-Rodriguez, Byron H Lee, Juan P Cata","doi":"10.1136/rapm-2025-106433","DOIUrl":"https://doi.org/10.1136/rapm-2025-106433","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374409","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":"Role of spinal Barrier-to-Autointegration Factor (BAF) in the epigenetic silencing of the mu-opioid receptor gene in neuropathic pain.","authors":"Ming-Chun Hsieh, Cheng-Yuan Lai, Tzer-Bin Lin, Hsueh-Hsiao Wang, Jen-Kun Cheng, Po-Sheng Yang, Chieh-Chien Hsu, Dylan Chou, Hsien-Yu Peng","doi":"10.1136/rapm-2024-106004","DOIUrl":"https://doi.org/10.1136/rapm-2024-106004","url":null,"abstract":"<p><strong>Background: </strong>Neuropathic pain presents a significant clinical challenge, with spinal cord epigenetic mechanisms playing a critical role in its development. This study investigated the impact of nerve injury on the Barrier-to-Autointegration Factor (BAF) in the rat spinal dorsal horn.</p><p><strong>Methods: </strong>Adult Sprague-Dawley rats underwent spinal nerve ligation (SNL) to model neuropathic pain. Pain behaviors were assessed using von Frey and burrow tests. Biochemical analyses measured mRNA and protein expression in the dorsal horn.</p><p><strong>Results: </strong>SNL elevated BAF levels, which interacts with LEM domain-containing protein 2 (LEMD2), activating the histone-modifying enzyme EZH2. This enzyme adds a gene-silencing mark, H3K27me3, to the promoter region of the <i>Oprm1</i> gene, which encodes the mu-opioid receptor. Consequently, the expression of the mu-opioid receptor is decreased, potentially contributing to neuropathic pain. Using gene knockdown techniques to reduce BAF expression, we reversed the changes in LEMD2, EZH2, and mu-opioid receptor expressions induced by SNL and attenuated mechanical allodynia. Additionally, knocking down LEMD2 disrupted the binding of BAF to the <i>Oprm1</i> promoter, without affecting BAF levels. Inhibiting EZH2 also reversed the signaling without altering BAF and LEMD2 levels. Glutamate activated BAF pathways via pNR2B receptors, and NR2B receptor blockade reversed this effect.</p><p><strong>Conclusion: </strong>These findings suggest that spinal pNR2B receptors may activate BAF, which interacts with LEMD2 to enhance EZH2-mediated H3K27me3 at the mu-opioid receptor promoter after nerve injury. Targeting this pathway may offer novel strategies to inhibit neuropathic pain.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366822","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":"Tackling the challenge of chronic postsurgical pain: from biomarkers to peripheral nerve blocks to transitional pain services and everything in between.","authors":"Eric S Schwenk","doi":"10.1136/rapm-2024-106042","DOIUrl":"10.1136/rapm-2024-106042","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":"50 2","pages":"75-76"},"PeriodicalIF":5.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257385","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":"N-Methyl-D-aspartate receptor antagonists for the prevention of chronic postsurgical pain: a narrative review.","authors":"Jeffrey Jon Mojica, Grace Eddy, Eric S Schwenk","doi":"10.1136/rapm-2024-105612","DOIUrl":"10.1136/rapm-2024-105612","url":null,"abstract":"<p><p>The N-methyl-D-aspartate receptor (NMDAR) has been linked to the development of chronic postsurgical pain (CPSP), defined as pain after surgery that does not resolve by 3 months. Once the combination of a painful stimulus and glutamate binding activates the NMDAR, calcium influx triggers signaling cascades that lead to processes like central sensitization and CPSP. Three of the most widely studied perioperative NMDAR antagonists include ketamine, magnesium, and methadone, with ketamine having garnered the greatest amount of attention. While multiple studies have found improved analgesia in the acute postoperative period, fewer studies have focused on long-term outcomes and those that have are often underpowered for CPSP or have not included those patients at highest risk. Existing meta-analyses of ketamine for CPSP are inconsistent in their findings, and studies of magnesium and methadone are even more limited. Overall, the evidence supporting NMDAR antagonists for CPSP is weak and we recommend that future studies focus on high-risk patients and potentially include combinations of NMDAR antagonists administered together for the longest duration feasible. The results of ongoing trials could have a major influence on the overall direction of the evidence supporting NMDAR antagonists in preventing CPSP.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":"50 2","pages":"160-167"},"PeriodicalIF":5.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257234","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}