Regional Anesthesia and Pain Medicine最新文献

{"title":"Prolonging peripheral ropivacaine nerve block with an in situ-formed hydrogel carrier: randomized controlled trial in an ovine model.","authors":"Hans Vangsnes Vingen, Ana Ćuk, Axel R Sauter, Olav Spigset, Finn Andersen, Fredrik Strebel Skedsmo, Marianne Hiorth, Marija T Garvin, Tor Å Myklebust, Audun Stubhaug, Henning A Haga","doi":"10.1136/rapm-2026-108092","DOIUrl":"https://doi.org/10.1136/rapm-2026-108092","url":null,"abstract":"<p><strong>Background: </strong>Local anesthetics are effective for regional anesthesia but have a relatively short duration of action. This motivates the development of sustained-release delivery systems. The aim of this study was to evaluate whether an in situ-forming hydrogel composed of poloxamers and alginate could prolong the duration of ropivacaine-induced sensory and motor blockade.</p><p><strong>Methods: </strong>In this randomized and blinded two-period cross-over study, 10 female sheep received ultrasound-guided sciatic nerve injections of either 200 mg ropivacaine poloxamer-alginate hydrogel (Rop-HG) or 200 mg, as a control, plain ropivacaine solution (Rop-C). Sensory and motor functions were assessed repeatedly using a standardized clinical scoring system. Plasma ropivacaine concentrations were measured over time, and postmortem histopathological evaluation of the sciatic nerve and surrounding tissues was performed.</p><p><strong>Results: </strong>Rop-HG markedly prolonged block duration compared with Rop-C, increasing the median (IQR) sensory block from 24 hours (IQR 16-36) to 60 hours (IQR 60-72) and the median motor block from 16 hours (IQR 16-18) to 60 hours (IQR 36-72). Pharmacokinetic analysis showed a sharp early peak for Rop-C (median C_max 5101 nmol/L and median T_max 0.33 hours), whereas Rop-HG produced a lower and delayed profile (median C_max 558 nmol/L and median T_max 8 hours). Histopathology revealed more pronounced and persistent local tissue reactions in Rop-HG-treated limbs, characterized by degeneration, necrosis, and inflammation.</p><p><strong>Conclusion: </strong>Ultrasound-guided perineural injections of 200 mg Rop-HG substantially prolonged the clinical duration of sciatic nerve block and reduced early systemic exposure compared with a 200 mg plain ropivacaine solution. However, the formulation was associated with severe local tissue degeneration, necrosis, and inflammation. Consequently, it remains unclear whether the prolonged clinical effect resulted from a sustained pharmacological release of ropivacaine or from the local tissue toxicity. Further optimization of the formulation is required before clinical translation.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888878","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":"Procedure-specific effects of intravenous lidocaine in adult spine surgery: a systematic review and meta-analysis of randomized controlled trials.","authors":"Vitor A Felippe, Carlos D A Bersot, Gabriel L Gonzalez, Gustavo R M Wegner, Estevao L C Braga, Carolina C C Silva, Giulia D Matheus, Bruno V M Santiago, Leonardo B Santos, Marcos A Lessa","doi":"10.1136/rapm-2026-108266","DOIUrl":"https://doi.org/10.1136/rapm-2026-108266","url":null,"abstract":"<p><strong>Background and objectives: </strong>Perioperative intravenous lidocaine infusion has been proposed as an opioid-sparing analgesic adjunct in spine surgery, but previous meta-analyses pooled heterogeneous procedures and may have obscured procedure-specific treatment effects. We evaluated the analgesic and opioid-sparing effects of perioperative intravenous lidocaine in adult spine surgery and whether efficacy differs by procedure type.</p><p><strong>Methods: </strong>We searched PubMed, Embase, Web of Science, and the Cochrane Library from inception through June 2026 for randomized controlled trials comparing perioperative intravenous lidocaine infusion with placebo or standard care in adults undergoing spine surgery. The primary outcome was postoperative pain intensity at 24 hours. Secondary outcomes were opioid consumption, postoperative nausea and vomiting (PONV), and hospital length of stay (LOS). Random-effects meta-analyses, a post hoc subgroup analysis by procedure type, and meta-regression were performed.</p><p><strong>Results: </strong>10 randomized trials were included. Intravenous lidocaine reduced postoperative pain at 24 hours (9 trials, 655 patients; mean difference (MD), -0.83; 95% CI -1.36 to -0.30; p=0.002; I²=89%, 95% CI 81% to 93%; prediction interval, -2.69 to 1.02; moderate certainty) and opioid consumption (9 trials; MD, -11.64 mg intravenous morphine equivalents; 95% CI -16.14 to -7.14; p<0.001). In a post hoc exploratory analysis, the analgesic effect differed by procedure type (test for subgroup differences, p=0.005): the reduction was clinically meaningful after instrumented fusion or complex spine surgery (MD, -1.23; 95% CI -1.81 to -0.64), exceeding the minimal clinically important difference of 1.0 point, but minimal after decompression (MD, -0.20; 95% CI -0.61 to 0.21). Baseline pain severity explained approximately 53% of between-study heterogeneity, whereas lidocaine infusion rate did not modify the treatment effect (p=0.97). No significant effects were observed for PONV or LOS.</p><p><strong>Conclusions: </strong>There is moderate-certainty evidence that perioperative intravenous lidocaine reduces postoperative pain and opioid consumption after adult spine surgery. Its analgesic benefit appeared procedure-specific, with the greatest benefit after instrumented fusion and complex procedures; this difference emerged from a post hoc, exploratory analysis and should be regarded as hypothesis-generating.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889408","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":"<i>In Reply to</i> \"Integrated local anesthetic delivery with peripheral nerve stimulation using perineural catheter: A welcome extension of prior findings\".","authors":"Brian M Ilfeld, Engy T Said, Brian H Park, Sanjay K Sinha, John J Finneran","doi":"10.1136/rapm-2026-108457","DOIUrl":"https://doi.org/10.1136/rapm-2026-108457","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889400","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 gastric point-of-care ultrasound is indeterminate: an educational review and suggested reporting framework.","authors":"Stephen C Haskins, Cristian Arzola, Yuriy Bronshteyn, Hari Kalagara, David Hardman, Oliver Panzer, Marissa M Weber, Eric Heinz, Jan Boublik, Javier Cubillos, Nadia Hernandez, Joshua Zimmerman, Anahi Perlas","doi":"10.1136/rapm-2026-108202","DOIUrl":"https://doi.org/10.1136/rapm-2026-108202","url":null,"abstract":"<p><p>Gastric point-of-care ultrasound (POCUS) is increasingly used to support aspiration-risk assessment when fasting history, comorbidities, medication exposure, or procedural urgency make clinical assessment uncertain. Its value depends on more than identifying gastric contents when images are clear. A useful examination must be attempted, completed, interpreted, and connected to a safe clinical decision. This article uses a focused secondary analysis of the 65 studies included in the original narrative review of gastric POCUS in medically complex patients to examine how indeterminate and non-interpretable examinations are reported. In the 65-study narrative-review evidence base, 32 studies reported at least one indeterminate or non-interpretable examination, 24 reported no or zero such examinations, and nine had unclear or non-numeric reporting. The main reporting concern is that studies often do not clearly identify scans that were not performed, scans that were started but not completed, images that were technically inadequate, results that were uncertain despite visualization, and interpretable diagnostic findings. Clinically, an indeterminate gastric POCUS examination is non-diagnostic and should cause the clinician to either rely on the original aspiration-risk assessment and management plan or choose a more cautious plan when the clinical situation warrants. A clearer reporting pathway can make future gastric POCUS studies easier to interpret, compare, teach, and apply safely.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882541","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":"Wrong-site procedure reporting in the USA: a 51-jurisdiction analysis centered on wrong-site blocks.","authors":"Uchenna O Umeh, Zachary Li, Chang Lu, Kellie Jaremko, Jinlei Li, Bridget P Pulos","doi":"10.1136/rapm-2026-108245","DOIUrl":"https://doi.org/10.1136/rapm-2026-108245","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148852112","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":"New persistent opioid use: a case for defining the problem.","authors":"Duncan Taylor Ritchie","doi":"10.1136/rapm-2026-108287","DOIUrl":"https://doi.org/10.1136/rapm-2026-108287","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148852137","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":"Gastric point-of-care ultrasound in patients on GLP-1 receptor agonists: additional evidence for residual gastric content but not for pulmonary aspiration.","authors":"Nils Vlaeminck","doi":"10.1136/rapm-2026-108307","DOIUrl":"https://doi.org/10.1136/rapm-2026-108307","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148852068","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":"Continuous femoral nerve blocks versus adductor canal blocks for anterior cruciate ligament surgery: a double-blind, superiority randomized controlled trial.","authors":"Justin Christopher Chen, Claudia Florez Denoue, Audrey Horn, Ksenia Kasimova, Zackary Vaughn, Jean-Louis Horn","doi":"10.1136/rapm-2026-107940","DOIUrl":"10.1136/rapm-2026-107940","url":null,"abstract":"<p><strong>Background: </strong>Peripheral nerve blockade is a common analgesic technique in anterior cruciate ligament (ACL) reconstruction. The comparative opioid-sparing and functional outcomes of continuous femoral nerve block (CFNB) versus continuous adductor canal block (CACB) are unclear.</p><p><strong>Methods: </strong>In this single-center, double-blind, prospective, superiority randomized controlled trial, 60 adults undergoing ACL reconstruction were randomized to receive either CFNB or CACB. All patients received a 20 mL loading dose of 0.5% ropivacaine and were discharged with a 0.2% ropivacaine infusion (5 mL/hour basal, 5 mL demand bolus, 30 min lockout). The primary outcome was average numeric rating scale (NRS) pain scores analyzed using a linear mixed-effects repeated-measures model over 48 hours. Secondary outcomes included cumulative morphine milligram equivalents (MME), continuous passive motion (CPM) usage, CPM compliance, and Quality of Recovery-15 (QoR-15) scores.</p><p><strong>Results: </strong>57 patients completed the study (CFNB n=28; CACB n=29). Mixed-effects repeated-measures analysis of average NRS pain scores at 24 and 48 hours showed no significant difference between CFNB and CACB. The estimated overall treatment effect for CFNB versus CACB was -0.31 NRS points (p=0.58, 95% CI -1.39 to 0.77), with no significant treatment-by-time interaction (p=0.97). Current NRS pain scores were lower for CFNB on postoperative day 0 (POD0) (p<i>=</i>0.02, 95% CI 6.44×10^-6 to 2.00). In an exploratory analysis, fewer CFNB patients required more than 50 MME during the 48-hour follow-up period compared with CACB (CFNB: 5/28 vs CACB: 13/29; p<i>=</i>0.045, 95% CI 0.08 to 0.93). The absolute risk difference was 0.27 (95% CI -0.08 to 0.54). There were no differences in CPM use or compliance, bolus volume, or QoR-15.</p><p><strong>Conclusions: </strong>CFNB was not superior to CACB on the primary pain outcome over 48 hours. In secondary analysis, CFNB catheters were associated with lower immediate postoperative pain. In exploratory analyses, fewer patients required more than 50 MME over 48 hours. This finding is hypothesis-generating and requires confirmation in an adequately powered trial. There were no differences in quality of recovery or CPM compliance. Whether any opioid-related differences between techniques outweigh concerns about motor blockade warrants further investigation.</p><p><strong>Trial registration number: </strong>NCT03208478.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551564","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":"Integrated local anesthetic delivery with peripheral nerve stimulation using perineural catheter: a welcome extension of prior findings.","authors":"Rakesh V Sondekoppam, Ban C H Tsui, Vivian H Y Ip","doi":"10.1136/rapm-2026-108416","DOIUrl":"10.1136/rapm-2026-108416","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801668","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":"PTP1B in dorsal root ganglion nociceptors drives neuropathic pain via a presynaptic Src/GluN2B signaling pathway.","authors":"Xiao-Qin Li, Shu-Jin Wu, Rui-Li Sun, Wen-Jing Li, Yu-Hang Yang, Xi-Wu Liao, Zi-Yan Huang, Jia-Wei Zhang, Fan Sun","doi":"10.1136/rapm-2026-107766","DOIUrl":"https://doi.org/10.1136/rapm-2026-107766","url":null,"abstract":"<p><strong>Background: </strong>Neuropathic pain, a debilitating chronic condition, remains a major clinical challenge due to its complex pathogenesis and limited treatment options. Protein tyrosine phosphatase 1B (PTP1B), a key regulator of tyrosine phosphorylation, has been implicated in various diseases, yet its specific role and mechanism in nociceptive processing within the dorsal root ganglion (DRG) are poorly understood.</p><p><strong>Methods: </strong>To investigate this, we used peripheral nerve injury models to assess PTP1B expression in the DRG. We employed nociceptor-specific overexpression and targeted knockdown of PTP1B to evaluate its effect on neuropathic pain-like behaviors, including mechanical allodynia and negative affect. Furthermore, we used electrophysiological recordings of miniature excitatory postsynaptic currents and pharmacological inhibition targeting Src kinase and N-methyl-D-aspartate (NMDA) receptor GluN2B to delineate the underlying molecular mechanisms.</p><p><strong>Results: </strong>Peripheral nerve injury induced a sustained upregulation of PTP1B predominantly in non-peptidergic nociceptors of the DRG. Mimicking this upregulation through nociceptor-specific overexpression elicited robust neuropathic pain-like behaviors. Conversely, targeted PTP1B knockdown therapeutically reversed established pain hypersensitivity. Mechanistically, PTP1B interacted with and activated Src kinase by dephosphorylating its inhibitory site at Tyr529. This led to enhanced phosphorylation of the NMDA receptor GluN2B subunit at Tyr1472, increasing presynaptic glutamate release in the spinal dorsal horn, as evidenced by elevated miniature excitatory postsynaptic currents. Consequently, pharmacological inhibition of either GluN2B or Src largely reversed PTP1B-driven pain sensitization.</p><p><strong>Conclusions: </strong>Our findings identified PTP1B in DRG nociceptors as a critical upstream regulator of the presynaptic Src/GluN2B pathway, establishing it as a promising therapeutic target for the treatment of neuropathic pain.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801641","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}