Regional Anesthesia and Pain Medicine最新文献

{"title":"Image-guided alcohol neurolysis for treatment of chronic hip pain secondary to avascular necrosis.","authors":"Abeer Alomari, Napatpaphan Kanjanapanang, Philip Peng, Nimish Mittal","doi":"10.1136/rapm-2025-106915","DOIUrl":"https://doi.org/10.1136/rapm-2025-106915","url":null,"abstract":"<p><strong>Objective: </strong>This case series aims to assess the analgesic effectiveness and safety of percutaneous chemical denervation of the articular branches on anterior hip capsule in patients with refractory hip pain secondary to avascular necrosis (AVN).</p><p><strong>Methods: </strong>Nine patients with refractory chronic hip pain secondary to AVN underwent image-guided chemical neurolysis with 100% ethanol. Average pain scores were recorded at baseline, 1, 3 and 6 months after chemical neurolysis.</p><p><strong>Results: </strong>The average baseline pain score was 6.7±1.2 on the Numerical Rating Scale (NRS). Two out of the nine patients did not respond to chemical neurolysis. For the seven patients who responded, the average NRS decreased to (2.9±1.2) at 1 month and (3.0±1.4) at 3 months. Five out of these seven patients maintained 50% or greater pain relief at both 1 and 3 months. For the five patients who completed the 6-month follow-up, the average NRS pain score was (3.0±1.7), with three of these patients maintaining 50% or greater pain relief. No one reported side effects or complications during the follow-up period.</p><p><strong>Conclusions: </strong>In conclusion, alcohol neurolysis of the hip joint can be offered as an effective and safe modality for pain control in patients with AVN who failed conservative management. This small case series serves as a pilot for future large cohort studies.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978908","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":"Inadvertent intrapleural placement of a thoracic epidural catheter identified during robotic-assisted video-assisted thoracoscopic surgery (VATS).","authors":"Neslida Kodra, Adam Sugarman, Alexis Garcia, Guillermo Garcia","doi":"10.1136/rapm-2025-107022","DOIUrl":"https://doi.org/10.1136/rapm-2025-107022","url":null,"abstract":"<p><strong>Background: </strong>Thoracic epidural analgesia is widely considered the gold standard for perioperative pain control in thoracic surgery. Despite its benefits, placement is technically challenging and can result in rare complications such as catheter misplacement into the intrapleural space.</p><p><strong>Case presentation: </strong>This case report will discuss a female patient in her late 70s with scoliosis and obesity who underwent robotic-assisted video-assisted thoracoscopic surgery for a pulmonary mass. The thoracic epidural catheter placed preoperatively was later directly visualized in the intrapleural space during the procedure. The catheter was immediately removed with no complications.</p><p><strong>Conclusion: </strong>Thoracic epidural placement can be challenging due to patient factors, such as positioning, age, body habitus, and spinal deformities, as well as the inherent anatomy of the thoracic spine.Inadvertent intrapleural catheter misplacement is likely an under-reported complication that can lead to pneumothorax, hemothorax, and inadequate pain control; however, some catheters left in place have successfully been used for analgesia.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978852","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":"Voluntary registry-based analysis of risk factors for accidental dural puncture in epidural anesthesia.","authors":"Henrik Hans Jörnvall, Sharon Orbach-Zinger, Alexandra M J V Schyns-van den Berg","doi":"10.1136/rapm-2025-106933","DOIUrl":"https://doi.org/10.1136/rapm-2025-106933","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978942","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":"Anatomical study of the superficial cervical plexus targeted for sensory nerve blocks in neonates.","authors":"Lané Prigge, Adrian T Bosenberg, Albert N van Schoor","doi":"10.1136/rapm-2025-106997","DOIUrl":"https://doi.org/10.1136/rapm-2025-106997","url":null,"abstract":"<p><strong>Introduction: </strong>The superficial cervical plexus block can be used to provide perioperative analgesia in pediatric patients undergoing thyroid surgeries, brachial cleft cyst excision, tympano-mastoid surgery, as well as cochlear implantation. The cervical plexus is formed by the first four cervical spinal nerves, and the superficial cutaneous branches emerge from the posterior border of the sternocleidomastoid muscle, often referred to as the \"nerve point of the neck.\" The aims of this study were to evaluate the location of this nerve point and formulate a standardized method of blocking the superficial cervical plexus in pediatric patients.</p><p><strong>Methods: </strong>The nerve point of the neck and the superficial branches of the cervical plexus were dissected and exposed on 22 neonatal cadavers from the Department of Anatomy, University of Pretoria, after ethical clearance was obtained. The distances between the nerve point and predetermined landmarks were calculated.</p><p><strong>Results: </strong>The nerve point was located 17.51 mm from the sternocleidomastoid muscle attachment at the rudimentary mastoid process and 19.80 mm from the clavicular attachment of the muscle. The nerve point is approximately 20.99 mm from the midline of the neck, and the superior border of the thyroid cartilage corresponds to the level of the nerve point in 83.3% of neonatal dissections.</p><p><strong>Conclusion: </strong>The superficial cervical plexus can be blocked along the midpoint of the posterior border of the sternocleidomastoid muscle, at the level of the superior border of the thyroid cartilage. This research will assist in the successful performance of sensory nerve blocks in pediatric patients.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978902","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":"Superficial parasternal intercostal plane blocks with liposomal bupivacaine did not significantly reduce opioid use after cardiac surgery: a randomized clinical trial.","authors":"Eric R Simon, Alysan Mallery, John Silva, Andreas de Biasi, Satoru Osaki, Bryan M Krause, Patrick Meyer","doi":"10.1136/rapm-2025-106952","DOIUrl":"https://doi.org/10.1136/rapm-2025-106952","url":null,"abstract":"<p><strong>Background: </strong>Acute pain after cardiac surgery via median sternotomy is commonly managed with multimodal analgesia, but optimal regional techniques remain uncertain. Superficial parasternal intercostal plane (SPIP) blocks have shown promise for postoperative pain control, with the use of catheters extending these benefits up to three days. This study evaluated the efficacy of single-injection SPIP blocks with liposomal bupivacaine in reducing opioid consumption following cardiac surgery.</p><p><strong>Methods: </strong>In this prospective, randomized, double-blind controlled trial, 100 patients undergoing elective coronary artery bypass grafting or valve surgery via median sternotomy were randomized to receive bilateral SPIP blocks with either a mixture of bupivacaine and liposomal bupivacaine or saline placebo prior to incision. The primary outcome was total opioid consumption in oral morphine milligram equivalents (MME) over the first 72 postoperative hours. Secondary outcomes included pain scores, time to extubation, intensive care unit (ICU) and hospital length of stay and opioid use at 90 days.</p><p><strong>Results: </strong>Total opioid consumption in the first 72 hours was not significantly different between groups (SPIP intervention: 165 (IQR 103-284) MME vs saline placebo: 205 (IQR 145-282) MME, p=0.30). Pain scores, extubation time, ICU and hospital length of stay, and opioid use at 90 days were also similar between groups. No serious adverse events were reported.</p><p><strong>Conclusions: </strong>Preincision bilateral SPIP blocks with a mixture of bupivacaine and liposomal bupivacaine did not significantly reduce opioid consumption or improve postoperative analgesic outcomes compared with saline placebo in cardiac surgical patients. These findings suggest that single-injection SPIP blocks with liposomal bupivacaine may not be as effective as repeated injections or catheters in cardiac surgical patients. Further studies should explore modifications to block techniques such as multilevel injections, the timing of the block relative to surgery, alternative local anesthetics, and strategies specifically targeting chest tube-related pain.</p><p><strong>Trial registration number: </strong>NCT04928339.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978879","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":"Association between preoperative obstructive sleep apnea diagnosis and prolonged postoperative opioid use among patients undergoing common surgical procedures.","authors":"Anjali A Dixit, Akash Shanmugam, Christine Y Kim, Chris A Rishel, Eric C Sun, Anthony G Doufas","doi":"10.1136/rapm-2025-106674","DOIUrl":"10.1136/rapm-2025-106674","url":null,"abstract":"<p><strong>Background: </strong>Identifying modifiable patient-related risk factors may guide interventions aimed at reducing prolonged postoperative opioid use. Obstructive sleep apnea (OSA) has been hypothesized as one such condition. However, the association between an OSA diagnosis and prolonged postoperative opioid use remains unclear.</p><p><strong>Methods: </strong>Using administrative healthcare claims data from the MarketScan Commercial and Medicare Claims Databases, we examined the association between preoperative OSA, defined as two or more prior claims with the OSA International Classification of Diseases 10th revision (ICD-10) diagnosis code, and prolonged postoperative opioid use, defined as filling ≥10 prescriptions or ≥120 days' supply of opioids during postoperative days 91-365, using multivariable logistic regression. Our sample consisted of opioid-naïve patients undergoing 11 surgeries (total knee arthroplasty, total hip arthroplasty, appendectomy, cholecystectomy, operative management of small bowel obstruction, diverticulitis, hernia, gonadal torsion, ectopic pregnancy, and aortic aneurysm) between 2016 and 2021.</p><p><strong>Results: </strong>Our final sample included 270 320 patients with a mean age of 49.58; 29 095 (10.8%) had a diagnosis of OSA. The unadjusted incidence of prolonged postoperative opioid use was 0.6% (95% CI 0.5 to 0.7) for patients with OSA versus 0.4% (95% CI 0.4 to 0.4) for those without OSA. After adjusting for confounders, the incidence was 0.4% for both groups (difference 0.0%, 95% CI -0.1 to 0.0, p=0.184). Results were robust to alternate specifications of outcome, exposure, and cohort.</p><p><strong>Conclusions: </strong>A preoperative OSA diagnosis was not associated with a change in the risk of prolonged postoperative opioid use across common surgical procedures, suggesting that a preoperative OSA diagnosis may not be a modifiable risk factor impacting prolonged postoperative opioid use.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12502924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978944","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":"National trends in naloxone codispensing with outpatient opioid prescriptions, 2013-2023.","authors":"Evan J Beck, Kao-Ping Chua, Vidhya Gunaseelan, Mark Bicket, Chad M Brummett, Amy Bohnert, Jennifer F Waljee","doi":"10.1136/rapm-2025-106911","DOIUrl":"10.1136/rapm-2025-106911","url":null,"abstract":"<p><strong>Background: </strong>Increasing access to naloxone, an opioid antagonist, can prevent opioid overdose among patients prescribed opioids. In 2016, the Centers for Disease Control and Prevention recommended coprescribing naloxone with opioids; however, the extent to which this guideline influenced clinical practice remains unclear. In this study, we seek to describe trends in the rate of naloxone codispensing with opioid prescriptions from 2013 to 2023.</p><p><strong>Methods: </strong>This serial cross-sectional analysis used the IQVIA Longitudinal Prescription Database, which captures 92% of dispensed US retail prescriptions, to examine opioid prescriptions dispensed to individuals aged 12 years and older between January 1, 2013 and September 30, 2023. Naloxone codispensing was defined as naloxone dispensed within 3 days of the opioid dispensing date. Subgroup analyses included high-risk opioid prescriptions, long-term opioid therapy, and prior dispensing of buprenorphine for opioid use disorder.</p><p><strong>Results: </strong>From 2013 to 2023, 1 690 391 169 opioid prescriptions were dispensed, with naloxone codispensing occurring in 3 531 421 (0.2%) cases, increasing from 0.0% in 2013 to 0.9% in 2023. Naloxone codispensing increased from 0.0% to 1.3% among high-risk prescriptions, from 0.0% to 0.7% for long-term opioid therapy, and from 0.0% to 1.8% for prior buprenorphine recipients during the study period.</p><p><strong>Conclusions: </strong>In this analysis of a national prescription dispensing database, naloxone codispensing with prescription opioids increased for 2013-2023 but remained infrequent, even among individuals at elevated risk for opioid overdose. Although these data do not capture naloxone obtained through prior prescriptions or free distribution programs, these findings emphasize the need for targeted interventions to promote naloxone codispensing. Clinician education, policy measures, and continued community outreach may help increase naloxone uptake and improve access for at-risk patients.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884315","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":"Pain catastrophizing: a trait or a state?","authors":"Kanishka Rajput, Benjamin A Fujita-Howie, Xiwen Zhao, Hung-Mo Lin, Robert Chow","doi":"10.1136/rapm-2025-107047","DOIUrl":"https://doi.org/10.1136/rapm-2025-107047","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876877","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":"Long-term outcomes of amputation in patients with complex regional pain syndrome (CRPS): a mixed-methods study.","authors":"Daniël Pc van der Spek, Julian Ghantous, Tjebbe Hagenaars, Marieke A Paping, Frank Jpm Huygen, Maaike Dirckx","doi":"10.1136/rapm-2025-106918","DOIUrl":"https://doi.org/10.1136/rapm-2025-106918","url":null,"abstract":"<p><strong>Introduction: </strong>Amputation in patients with complex regional pain syndrome (CRPS) remains controversial, with variable outcomes in quality of life (QoL), disability, pain reduction, and complications. This study aims to evaluate long-term outcomes in CRPS patients who underwent amputation.</p><p><strong>Methods: </strong>We conducted a single-center retrospective observational study combined with a cross-sectional survey of all CRPS patients who underwent limb amputation between 2003 and 2023 at the Erasmus MC University Medical Center. Preamputation and short-term postamputation outcomes were extracted from medical records, with short-term pain scores reflecting measurements within the first year after amputation. Long-term outcomes, including QoL, disability, pain, and satisfaction, were assessed through patient-reported questionnaires. Subgroup analyses were performed based on the presence of a neurostimulator implant.</p><p><strong>Results: </strong>A total of 39 patients with a median CRPS Severity Score of 12 (IQR 11-13) were included. 34 patients (87%) completed the survey a median of 6.4 years (IQR 3.0-11.7) after amputation. The 36-Item Short Form Health Survey yielded mean physical and mental health summary scores of 45.4 (±26.1) and 67.7 (±22.3), respectively. The mean Pain Disability Index score was 29.3 (±15.1). Pain decreased by a mean of 3.54 points (95% CI: 2.46 to 4.62) at short-term follow-up (median 5 months, IQR 2-6) and 2.71 points (95% CI: 1.76 to 3.65) at long-term follow-up. Residual limb pain occurred in 77%, phantom limb pain in 85%, and CRPS recurrence in the stump in 10%. Overall, 94% of respondents were satisfied and would choose amputation again. Neurostimulator status did not influence measured outcomes.</p><p><strong>Conclusions: </strong>In this cohort of severe, therapy-resistant CRPS, amputation was associated with meaningful improvements in QoL, disability, and pain in carefully selected cases, although complications remained common. Amputation should, therefore, be reserved as a last-resort intervention, offered only in specialized multidisciplinary centers.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876876","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":"Effectiveness of multimodal analgesia on surgically treated geriatric hip fracture patients: a propensity score matching analysis.","authors":"Eic Ju Lim, Chul-Ho Kim, Ji Wan Kim","doi":"10.1136/rapm-2025-106781","DOIUrl":"https://doi.org/10.1136/rapm-2025-106781","url":null,"abstract":"<p><strong>Background: </strong>To investigate whether multimodal analgesia can decrease pain scores while reducing opioid usage.</p><p><strong>Methods: </strong>This retrospective comparative study was performed in a single institution. Data were collected from medical records between January 2008 and December 2023 for patients who underwent surgical treatment for hip fracture (femoral neck, intertrochanteric, and subtrochanteric fractures). A standardized multimodal analgesia protocol for hip fracture, encompassing a systematic approach for analgesic prescription, anesthesia type, and regional nerve block, was implemented starting in 2022. We excluded the years 2019-2021 as a transition period. Patients treated between 2008 and 2018 formed the group without multimodal analgesia (the control group, n=1088), and those treated between 2022 and 2023 formed the multimodal analgesia group (n=306). Using propensity score matching, we matched patients in the multimodal analgesia group 1:1 to those in the control group. Primary outcomes were pain scores (visual analog scale: 6 hours, 12 hours, 24 hours, and 48 hours postoperatively) and oral opioid use within 48 hours postoperatively, both compared between the two groups. Rehabilitation rates, postoperative complications, and mortality were also compared.</p><p><strong>Results: </strong>Following propensity score matching, each group included 280 patients. The mean age was 75.5±11.9 years (range, 20-99 years) and 76.9±11.7 years (range, 35-99 years) in the control group and multimodal analgesia group, respectively. Male patients accounted for 31% and 30%, respectively. Postoperatively, the multimodal analgesia group showed lower pain scores (6 hour: 1.9 vs 2.9, p<0.001; 24 hours: 2.0 vs 2.4, p=0.001; 48 hours: 1.7 vs 2.2, p<0.001) and 48-hour opioid usage (5.5 vs 13.3 mg, p=0.014).</p><p><strong>Conclusions: </strong>Our findings showed that implementing a multimodal analgesia protocol for hip fracture surgery was associated with lower postoperative pain and reduced opioid consumption, supporting the adoption of multimodal analgesia as a standardized perioperative pain management approach in geriatric patients with hip fractures.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876875","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}