Regional Anesthesia and Pain Medicine最新文献

{"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}

{"title":"Mepivacaine versus bupivacaine spinal anesthesia for return of motor function following total knee arthroplasty: a randomized controlled trial.","authors":"Clinton F Pillow, Carey Brewbaker, Bethany J Wolf, William Barrett, Erik Hansen, Andrew Brown, Dylan Crawford, Sylvia H Wilson","doi":"10.1136/rapm-2024-106342","DOIUrl":"https://doi.org/10.1136/rapm-2024-106342","url":null,"abstract":"<p><strong>Background: </strong>Demand for same-day discharge pathways and early ambulation following knee arthroplasty continues to increase. While spinal anesthesia with mepivacaine versus bupivacaine may promote return of motor function and ambulation, there are limited randomized trials evaluating this in knee arthroplasty patients. This study hypothesized that spinal mepivacaine would result in earlier return of motor function, promoting ambulation and same-day discharge.</p><p><strong>Methods: </strong>Patients undergoing primary total knee arthroplasty (n=163) were enrolled and randomized patients to mepivacaine (60 mg) or isobaric bupivacaine (10 mg) for spinal anesthesia. The primary outcome was time to return of motor function. Additional outcomes included time to first ambulation, distance at first ambulation, same-day discharge rate, length of stay, postoperative pain, opioid consumption, and side effects.</p><p><strong>Results: </strong>Patients receiving a mepivacaine spinal anesthetic had faster median (95% CI) time to return of motor function, (210 min (200, 216) vs 229 (223, 237) min, p<0.001) and lower rates of urinary retention (36% vs 57%, p=0.007). Mepivacaine patients exhibited higher pain scores in the post-anesthesia care unit (32.4 vs 9.5 mm, p<0.001) but no differences at 6, 24, or 48 hours postoperative. Opioid consumption did not differ at any time point (p=0.769). There were no differences in time to first ambulation, distance at first ambulation, same-day discharge rate, length of stay, nausea, vomiting, pruritus, or transient neurological symptoms between groups.</p><p><strong>Conclusions: </strong>Although mepivacaine expedited return of motor function after knee arthroplasty, a clinically relevant 20% reduction was not observed. Ambulation times and same-day discharge rates did not differ.</p><p><strong>Trial registration number: </strong>NCT05765682.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046254","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":"Spinal anesthesia with mepivacaine versus bupivacaine: early start, same finish-an infographic.","authors":"Ryan S D'Souza, Clinton F Pillow, Sara Amaral","doi":"10.1136/rapm-2025-106710","DOIUrl":"https://doi.org/10.1136/rapm-2025-106710","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057833","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":"From spin wizardry to regenerative alchemy: a philosophical inquiry into healing and standardization.","authors":"Guilherme Ferreira-Dos-Santos","doi":"10.1136/rapm-2025-106689","DOIUrl":"https://doi.org/10.1136/rapm-2025-106689","url":null,"abstract":"<p><p>In Regenerative Medicine, the quest to harness the body's own healing potential is as much a philosophical journey as it is a clinical challenge. Promising interventions-from platelet-rich plasma injections to stem cell therapies-often differ in subtle yet critical ways, leading to variable outcomes. One method might modestly enrich bioactive components, while another yields a preparation bursting with regenerative signals. This variability compels us to ask: should we focus on merely categorizing these diverse approaches, or instead strive to define the fundamental nature of the therapeutic agents we deploy?This Daring Discourse explores the tension between the intricate diversity of human biology and our need for consistency and reproducibility in treatment. Drawing on the parable of the blind men and the elephant, it illustrates how isolated perspectives reveal only fragments of the truth; only by integrating these views can we grasp the full regenerative potential. It further cautions against the rise of \"spin wizards\"-clinicians who, relying solely on centrifugation without understanding underlying biological determinants, claim a universal cure for degenerative conditions.This narrative advocates for a unified framework that marries innovative techniques with rigorous standardization. Such an approach promises to transform Regenerative Medicine from a field of hopeful experiments into one where treatments are reliably safe and effective, ultimately fulfilling its transformative potential.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063290","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":"Re-evaluating pain management in patients with heart failure: a focus on left ventricular assist devices (LVADs).","authors":"Trishul Kapoor, Richard Rosenquist","doi":"10.1136/rapm-2025-106696","DOIUrl":"https://doi.org/10.1136/rapm-2025-106696","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026880","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":"Incidence of transient neurologic symptoms in patients receiving lidocaine spinal anesthesia for outpatient joint arthroplasty.","authors":"Sara Amaral, Emily Chen, Amanda H Kumar, David B MacLeod, W Michael Bullock, Neil Ray, Erin Manning, Hector Martinez-Wilson, Joshua Dooley, Brian Ohlendorf, Jeff Gadsden","doi":"10.1136/rapm-2025-106541","DOIUrl":"https://doi.org/10.1136/rapm-2025-106541","url":null,"abstract":"<p><strong>Background: </strong>Spinal anesthesia is commonly administered for lower limb total joint arthroplasty, but the prolonged motor and sympathetic block associated with bupivacaine can delay recovery. In contrast, lidocaine, with its swift onset and intermediate duration, is an attractive alternative that is well-tailored for outpatient lower limb surgery. It has historically been associated with transient neurologic symptoms (TNS), a self-limiting but potentially distressing pain syndrome. The incidence of TNS reported in older studies varies widely, often exceeding 20%, which has led to a decline in the use of lidocaine for spinal anesthesia.</p><p><strong>Objective: </strong>This study aimed to evaluate the contemporary incidence of TNS following lidocaine spinal anesthesia in the context of an established multimodal analgesic protocol for total knee and hip arthroplasty.</p><p><strong>Findings: </strong>A retrospective review of 1026 patients undergoing knee and hip arthroplasty with lidocaine spinal anesthesia was conducted. We queried our postoperative block database, which included questions specifically related to TNS, including the onset of new non-surgical back or thigh pain following resolution of the spinal block and any other associated symptoms related to TNS. Of the 1011 patients included in the final analysis, only two (0.2%, 95% CI 0.02 to 0.71%) were diagnosed with TNS, both of whom had mild, self-limited symptoms that resolved within 48-72 hours. No cases of prolonged motor or sensory block, cauda equina syndrome, or other significant complications were observed. The low incidence of TNS in this cohort contrasts sharply with historical reports and may be attributable to concurrent administration of comprehensive multimodal analgesics, including acetaminophen, non-steroidal anti-inflammatory drug, intravenous ketamine, and dexamethasone.</p><p><strong>Conclusions: </strong>Lidocaine spinal anesthesia for total joint arthroplasty is associated with a negligible incidence of TNS in the setting of multimodal analgesia. These findings challenge historical concerns regarding the safety of spinal lidocaine and support its use as a viable alternative for outpatient joint replacement surgery.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034564","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 remifentanil as an adjunct analgesic is not associated with clinically important opioid-induced hyperalgesia: secondary analysis from a randomized controlled trial.","authors":"Harsha Shanthanna, Maram A T M Khaled, Alvaro Diaz, Parsa Farsinejad, Sarah Clements","doi":"10.1136/rapm-2025-106483","DOIUrl":"https://doi.org/10.1136/rapm-2025-106483","url":null,"abstract":"<p><strong>Background: </strong>Remifentanil, as the primary opioid or in high doses, is associated with opioid-induced hyperalgesia. We assessed outcomes of pain and opioid use with low-dose remifentanil as an adjunct analgesic after same-day surgeries.</p><p><strong>Methods: </strong>This prospective cohort study was nested within a randomized controlled trial showing no difference in achieving satisfactory analgesia in the postanesthetic care unit with morphine or hydromorphone. Primary outcomes were pain scores in the postanesthetic care unit and 24 hours after surgery between patients who received remifentanil (R group) or those who received non-remifentanil opioid regimens (C group). We also evaluated pain scores in the day surgical unit, dose of long-acting opioids, and need for non-steroidal anti-inflammatory drugs. The association of remifentanil dose with outcomes was explored using linear regression.</p><p><strong>Results: </strong>Patients in both groups (R=276, C=126) had comparable baseline characteristics. There were no differences in maximum postanesthetic care unit pain scores or average pain scores 24 hours after surgery: mean difference 0.3 (95% CI -0.9 to 0.2) and 0.4 (95% CI -1.7 to 0.9), respectively. In the R group, the dose of long-acting opioids in postanesthetic care unit was higher: mean difference 0.97 mg (95% CI 0.2 to 1.7) intravenous morphine equivalents, p=0.01. Adjusted analyses indicated that higher doses of remifentanil (25 mcg increments) were associated with higher maximum pain scores in day surgical unit: 0.23 units (95% CI 0.05 to 0.41), p=0.01; higher average pain scores 24 hours after surgery: 0.25 units (95% CI 0.036 to 0.46), p=0.02; and higher long-acting opioid doses in postanesthetic care unit: 0.14 mg intravenous morphine equivalents (95% CI 0.02 to 0.25), p=0.02.</p><p><strong>Conclusion: </strong>Opioid-induced hyperalgesia and increased opioid requirement after low-dose remifentanil use is unlikely to be clinically significant.</p><p><strong>Trial registration number: </strong>NCT02223377.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050044","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":"Middle cluneal nerves and sacroiliac joint pain.","authors":"Victor M Silva-Ortiz","doi":"10.1136/rapm-2025-106688","DOIUrl":"https://doi.org/10.1136/rapm-2025-106688","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034596","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 the block: a canvas for well-being and conversation in anesthesiology and pain medicine.","authors":"Courtney Julia Burns, Morgan Granzow, Adam Was, Kenneth Elliott Higgins","doi":"10.1136/rapm-2025-106588","DOIUrl":"https://doi.org/10.1136/rapm-2025-106588","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052784","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 negative pressure wound therapy for infection control.","authors":"David Anthony Provenzano, Christine Hunt, Julie G Pilitsis, Samer Narouze","doi":"10.1136/rapm-2025-106663","DOIUrl":"https://doi.org/10.1136/rapm-2025-106663","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043358","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}