Regional Anesthesia and Pain Medicine最新文献

{"title":"5-year longitudinal follow-up of patients treated for chronic mechanical low back pain using restorative neurostimulation.","authors":"Simon Thomson, Adam Williams, Girish Vajramani, Manohar Sharma, Sarah Love-Jones, Rajiv Chawla, Sam Eldabe","doi":"10.1136/rapm-2025-106899","DOIUrl":"https://doi.org/10.1136/rapm-2025-106899","url":null,"abstract":"<p><strong>Background: </strong>Chronic mechanical low back pain (CLBP) often stems from dysfunction of the multifidus muscle, leading to impaired motor control and pain. Restorative neurostimulation has emerged as a novel treatment targeting this dysfunction by delivering electrical stimulation to the medial branches of the L2 dorsal rami to restore multifidus activation.</p><p><strong>Methods: </strong>This prospective, open-label, postmarket clinical follow-up study aimed to evaluate 5-year clinical outcomes and device utilization trends in a cohort of 42 patients with CLBP treated across five UK sites with restorative neurostimulation via an implanted ReActiv8 neurostimulation system. Patients were followed for 5 years, with assessments of pain (Numerical Rating Scale (NRS)), disability (Oswestry Disability Index (ODI)), and health-related quality of life (EuroQol-5 Dimension, 5 Level (EQ-5D-5L)) at baseline and regular intervals. Therapy utilization was collected via implantable device logs.</p><p><strong>Results: </strong>At 5 years, 34/42 patients (81%) completed follow-up. Significant and durable improvements were observed in pain (mean NRS reduced from 7.0 to 3.2), disability (mean ODI reduced from 46.6 to 26.1), and quality of life (EQ-5D index increased from 0.426 to 0.703). A total of 82% of patients achieved a minimally clinically important change in either pain or disability, and 62% were pain remitters (NRS ≤3). Device usage averaged 1106 hours over 5 years, with reductions in usage over time. Lower usage was associated with non-response, though causality could not be determined.</p><p><strong>Conclusions: </strong>Restorative neurostimulation provides robust, sustained improvements in pain, function, and quality of life in patients with CLBP associated with multifidus dysfunction. These results support its long-term efficacy and safety in real-world clinical practice.</p><p><strong>Trial registration number: </strong>ClinicalTrials.gov Identifier: NCT01985230.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857049","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":"Analgesic efficacy of popliteal plexus block versus infiltration between the popliteal artery and capsule of the posterior knee block combined with femoral triangle block after total knee arthroplasty: a randomized non-inferiority trial and cadaveric evaluation.","authors":"Takashi Fujino, Keiko Taga, Masahiko Odo, Hidaka Anetai, Haruka Kaneko, Saki Uchiyama, Mitsuaki Kubota, Yoshitomo Saita, Keiichi Yoshida, Shinnosuke Hada, Youngji Kim, Jun Shiozawa, Koichiro Ichimura, Muneaki Ishijima, Izumi Kawagoe","doi":"10.1136/rapm-2025-106895","DOIUrl":"https://doi.org/10.1136/rapm-2025-106895","url":null,"abstract":"<p><strong>Background: </strong>Both popliteal plexus block and infiltration between the popliteal artery and capsule of the posterior knee (IPACK) block can alleviate posterior knee pain after total knee arthroplasty (TKA) while preserving motor function. We aimed to assess whether popliteal plexus block is non-inferior to IPACK block in reducing posterior knee pain after TKA.</p><p><strong>Methods: </strong>Eighty-six participants undergoing elective TKA were randomized to receive popliteal plexus block or IPACK block combined with femoral triangle block. The primary outcome was moderate-to-severe posterior knee pain at eight postoperative hours. Secondary outcomes included pain scores, fentanyl consumption, sensorimotor function, range of motion, block performance time, quality of recovery, and participant satisfaction. Injectate spread in popliteal plexus block was also assessed in seven cadaveric legs.</p><p><strong>Results: </strong>The lower bound of the 90% CI for the between-group difference (IPACK - popliteal plexus block) in moderate-to-severe posterior knee pain did not exceed the 17% non-inferiority margin (difference=4.7, (90% CI -5.6 to 14.9; p<0.001)), demonstrating that popliteal plexus block was non-inferior to IPACK block. The block performance time (median (IQR)) was significantly shorter in the popliteal plexus block group (3 (3-5) min) than in the IPACK group (5 (5-6) min; p<0.0001). No significant difference in the preservation of motor function was observed. The posterior articular branches were stained in all the cadaveric specimens.</p><p><strong>Conclusions: </strong>Compared with the IPACK block, popliteal plexus block provides non-inferior posterior knee analgesia following TKA while maintaining ankle muscle strength, with the additional advantage of having a shorter block performance time.</p><p><strong>Trial registration number: </strong>UMIN000052472; URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000059848.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849611","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":"Ultrasound-guided cervical cervicis plane (CCeP) block: a cadaver study.","authors":"Prangmalee Leurcharusmee, Siriwat Thunyacharoen, Chirapat Inchai, Pasuk Mahakkanukrauh, Muhammad Shabsigh, Jeff L Xu","doi":"10.1136/rapm-2025-106962","DOIUrl":"https://doi.org/10.1136/rapm-2025-106962","url":null,"abstract":"<p><strong>Background: </strong>Ultrasound-guided cervical cervicis plane (CCeP) block has been described to anesthetize the dorsal rami of the cervical spinal nerves for postoperative analgesia in posterior cervical spine surgery. However, the anatomical characteristics and the spread pattern of local anesthetic within the CCeP layer remain inadequately studied. This study utilizes fresh cadaveric models to evaluate the spread of CCeP injections at the C2 and C5 levels, aiming to assess staining of the targeted cervical dorsal rami and to identify any spread to adjacent structures.</p><p><strong>Methods: </strong>Dye injection with 0.1% Methylene Blue was used to perform the CCeP block in 20 fresh frozen cadavers at either C2 or C5 level. The cadavers were dissected to evaluate the extent of dye spread within the CCeP layer.</p><p><strong>Results: </strong>Injections with 10 mL dye at the C2 level resulted in staining of the C2 and C3 dorsal rami consistently. Injections with 10 mL dye at the C5 level resulted in staining of the C3 to C5 dorsal rami consistently, but not above the C2 level of the CCeP layer. No staining of the multifidus muscle, retrolaminar region, or ventral rami was observed with either C2 or C5 injections.</p><p><strong>Conclusions: </strong>CCeP block can provide selective blockade of the cervical dorsal rami at multiple vertebral levels. The absence of staining in the multifidus muscle, retrolaminar region, or ventral rami demonstrates the potential for the CCeP block to avoid the risk of associated side effects.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823261","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":"Erector spinae plane block and postoperative nausea and vomiting.","authors":"Guanyu Yang, Qinjun Chu","doi":"10.1136/rapm-2025-107041","DOIUrl":"https://doi.org/10.1136/rapm-2025-107041","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818302","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 clavipectoral fascial plane block in light of the midclavicle block: clinical evidence and anatomical rationale.","authors":"Kartik Bapurao Sonawane, Tuhin Mistry","doi":"10.1136/rapm-2025-106958","DOIUrl":"https://doi.org/10.1136/rapm-2025-106958","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818303","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 and PONV: the need for risk-adjusted antiemetic prophylaxis.","authors":"Fabricio Andres Lasso Andrade, Carlos Restrepo-Garces","doi":"10.1136/rapm-2025-107014","DOIUrl":"https://doi.org/10.1136/rapm-2025-107014","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805327","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 entitled 'pain and PONV: the need for risk-adjusted antiemetic prophylaxis'.","authors":"Gokhan Erdem, Fatma Kavak Akelma, Burak Nalbant, Nihal Gökbulut Özaslan","doi":"10.1136/rapm-2025-107032","DOIUrl":"https://doi.org/10.1136/rapm-2025-107032","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805328","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":"Letter to the editor: methodological rigor when using big data analytic platforms.","authors":"Phillip J Schulte, Nafisseh Warner","doi":"10.1136/rapm-2025-107049","DOIUrl":"https://doi.org/10.1136/rapm-2025-107049","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796127","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":"0.25% bupivacaine-1% lidocaine vs 0.5% bupivacaine for ultrasound-guided infraclavicular brachial plexus block: a randomized controlled trial.","authors":"Germán Aguilera, Camilo Tabilo, Álvaro Jara, Julián Aliste","doi":"10.1136/rapm-2024-105511","DOIUrl":"10.1136/rapm-2024-105511","url":null,"abstract":"<p><strong>Introduction: </strong>In an effort to shorten onset time, a common practice is to add lidocaine to bupivacaine. In the setting of infraclavicular block, it is unclear what the block characteristics of this practice are compared with bupivacaine alone. We hypothesized that bupivacaine alone increases the duration of motor block, sensory block, and postoperative analgesia while resulting in a slower onset time compared with a bupivacaine and lidocaine mixture.</p><p><strong>Methods: </strong>40 patients receiving ultrasound-guided infraclavicular brachial plexus block were randomly assigned to receive either 35 mL of 0.25% bupivacaine and 1% lidocaine or 0.5% bupivacaine, both associated with perineural adjuvants (epinephrine 5 µg/mL and dexamethasone 4 mg). After the block was performed, a blinded observer evaluated the success of the block, the onset time, and the incidence of surgical anesthesia. Postoperatively, a blinded observer contacted patients who had successful blocks to inquire about the duration of motor block, sensory block, postoperative analgesia, and the presence of rebound pain.</p><p><strong>Results: </strong>When comparing patients having bupivacaine alone versus bupivacaine and lidocaine, the mean (SD) motor block duration was 28.4 (5.2) vs 18.9 (3.1) hours, respectively; the mean difference 9.5 hours (95% CI 6.5 to 12.4; p<0.001); the mean (SD) sensory block duration was 29.3 (5.8) vs 18.7 (4.0) hours, respectively; the mean difference 10.6 hours (95% CI 7.1 to 14.0; p<0.001); the mean (SD) postoperative analgesia duration was 38.3 (7.4) vs 24.3 (6.6) hours, respectively; the mean difference 14 hours (95% CI 9.2 to 18.8; p<0.001); and the median (IQR) onset time was 35 (15) vs 20 (10) min, respectively; p<0.001. No other significant differences were detected.</p><p><strong>Conclusions: </strong>Compared with mixed bupivacaine-lidocaine, 0.5% bupivacaine significantly prolongs sensorimotor block and postoperative analgesia at the expense of a delayed onset time.</p><p><strong>Trial registration number: </strong>NCT05834023.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"627-634"},"PeriodicalIF":3.5,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140960912","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":"Local anesthetic systemic toxicity from local infiltration anesthesia in total joint arthroplasty: a single center retrospective study.","authors":"Kacie Mitchell, Eiline Cai, Brady Miller, Kalan Jenkins, Russell K McAllister, Michael Fettiplace, Guy Weinberg, Kendall Hammonds, Michael P Hofkamp","doi":"10.1136/rapm-2023-104880","DOIUrl":"10.1136/rapm-2023-104880","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":" ","pages":"690-692"},"PeriodicalIF":3.5,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10891293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10071265","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}