REGIONAL ANESTHESIA AND PAIN MEDICINE

Taking a hard look at the 2024 match: a critical moment for the future of pain medicine training
Pritzlaff S, Sanghvi C and Singh N
Earlier preoperative percutaneous intercostal cryoanalgesia improves recovery after pectus excavatum surgery
Mariconti S, Bronco A, Pellicioli I, Chiudinelli L, Cattaneo M, Cheli M and Bonanomi E
Minimally invasive repair of pectus excavatum is associated with intense postoperative pain. We aimed to evaluate the effectiveness of percutaneous intercostal cryoanalgesia according to the different timing of its preoperative application. Outcome variables included pain, drug consumption, time to mobilization, and hospital length of stay.
Clinical study of a micro-implantable pulse generator for the treatment of peripheral neuropathic pain: 12-month results from the COMFORT-randomized controlled trial
Hatheway J, Hersel A, Engle M, Gutierrez G, Khemlani V, Kapural L, Moore G, Ajakwe R, Trainor D, Hah J, Staats PS, Makous J, Heit G, Kottalgi S, Desai MJ and
There is paucity of data from randomized controlled trials supporting the use of peripheral nerve stimulation, a well-established therapy for the treatment of chronic pain. This study was undertaken, in part, to provide randomized controlled trial data in support of patient access to appropriate peripheral nerve stimulation therapy. The COMFORT study is the first large, postmarket, multicenter randomized controlled trials investigating the use of a Food and Drug Administration-cleared micro-implantable pulse generator (IPG) for treating chronic pain via peripheral nerve stimulation therapy.
Skeletal muscle relaxant for the treatment of fibromyalgia: a systematic review and meta-analysis of randomized controlled trials
Shing CH, Wang F, Lau LNL, Lam PM, Ho HC and Wong SSC
Fibromyalgia is a complex chronic pain disorder that significantly impairs patient well-being. Evaluating the efficacy of muscle relaxants for treating fibromyalgia is crucial for improving patient care.
Dermatomal spread in lateral quadratus lumborum blocks versus transversus abdominus plane blocks after laparoscopic colorectal surgery: a randomized clinical trial
George RM, McSwain JR, Gukasov M, Wilson DA, Nitchie H and Wilson SH
Postoperative pain after laparoscopic abdominal surgery remains complex. While lateral quadratus lumborum (QL) block and transversus abdominus plane (TAP) block are similar techniques, no studies have examined if one technique has greater dermatomal spread.
Axonal sensitivity and block dynamics
Wildsmith JA
The role of differential nerve block in the development of analgesia after erector spinae plane block has been questioned. While highly myelinated nerves are more sensitive to local anesthetics than unmyelinated ones in vitro, factors influencing drug diffusion, particularly pKa, are more relevant in the clinical setting. Bupivacaine (the drug most used for an 'analgesic' effect) has a relatively high pKa (8.1), and only 15% of it is present in the lipid permeant, unionized form at pH 7.4 so it will penetrate unmyelinated C fibers relatively easily, but the myelin sheaths around other fiber types are a significant barrier to drug diffusion. The greater sensitivity of myelinated axons to local anesthetic action will only be apparent if the drug can reach their membranes in significant concentrations. In the very dynamic situation pertaining to a local anesthetic injection (no matter the site), diffusion factors mean that the concentration of the drug around the axons is likely to be very low and may result in an effect on unmyelinated fibers only.
KDM4A facilitates neuropathic pain and microglial M1 polarization by regulating BDNF in a rat model of brachial plexus avulsion
Guo J, Gao K, Chen X, Liao C, Rui J, Zhou Y and Lao J
Many patients with brachial plexus avulsion (BPA) suffer from neuropathic pain, but the mechanism remains elusive. Modifications of histones, the proteins responsible for organizing DNA, may play an important role in neuropathic pain. Lysine demethylase 4A (KDM4A), an essential component of histone demethylase, can modify the function of chromatin and thus regulate the vital gene expressions. However, the mechanism by which KDM4A regulates neuropathic pain following BPA remains unclear.
Structural changes in the nociceptive system induced by long-term conventional spinal cord stimulation in experimental painful diabetic polyneuropathy
Geus T, Franken G, Zuidema X, van Zundert J and Joosten EAJ
Clinical studies suggest that long-term conventional spinal cord stimulation (LT-SCS) for painful diabetic peripheral neuropathy (PDPN) is initially effective but may decline in efficacy over time. Preclinical studies indicate that LT-SCS alleviates mechanical hypersensitivity and enhances hind paw blood flow in PDPN rats, suggesting nociceptive system plasticity. This study hypothesized that LT-SCS induces peripheral hind paw small-fiber sprouting and reduces central protein expression of glial and P2X4 brain-derived neurotrophic factor (BDNF) pathway markers.
Intra-articular corticosteroid injections versus platelet-rich plasma as a treatment for cervical facetogenic pain: a randomized clinical trial
Allison DJ, Ebrahimzadeh S, Muise S, Joseph S, Roa Agudelo A, Lawson A, Billias N, Tran J, Smith A and Loh E
The study's primary objective was to compare the effectiveness of intra-articular platelet-rich plasma injections versus corticosteroid injections for the treatment of cervical facetogenic pain. Secondary aims were to compare self-rated disability, pain self-efficacy, and the safety of the procedure between groups.
Transversus abdominis plane block in minimally invasive colon surgery: a multicenter three-arm randomized controlled superiority and non-inferiority clinical trial
Salmonsen CB, Lange KHW, Kleif J, Krøijer R, Bruun L, Mikalonis M, Dalsgaard P, Hesseldal KB, Olsson JEP, Bertelsen CA and
The transversus abdominis plane (TAP) block is the most widely used abdominal field block in colorectal surgery with a postoperative enhanced recovery pathway. We aimed to determine whether the laparoscopic-assisted and ultrasound-guided TAP (US-TAP) blocks provide superior pain relief compared with placebo. We separately investigated whether the laparoscopic-assisted technique was non-inferior to the ultrasound-guided technique in providing pain relief, with a non-inferiority margin of 10 mg morphine dose equivalents.
Obturator canal block: an anatomical study
Labandeyra H, Goffin P, Riera R, Vallejo A, Prats-Galino A and Sala-Blanch X
Different approaches to the obturator nerve have been described. However, few have focused on the injection point inferior the iliopubic ramus, specifically at the exit of the obturator canal. This study aims to anatomically evaluate the ultrasound-guided obturator nerve block at the exit of the obturator canal, detailing anatomical landmarks and solution distribution.
Successful cutaneous sensory blockade following single-injection and double-injection techniques of ultrasound-guided superficial parasternal intercostal plane block: a randomized clinical trial
Samerchua A, Sroiwong C, Lapisatepun P, Leurcharusmee P, Pipanmekaporn T, Sukhupragarn W, Boonsri S, Bunchungmongkol N, Pansuan K and Phothikun A
While superficial parasternal intercostal plane blocks can improve analgesia after cardiac surgery, the optimal site and the number of injections remain uncertain. This study aimed to compare the efficacy of single versus double injections of superficial parasternal blocks, hypothesizing that double injections would achieve superior cutaneous sensory blockade.
Prevalence and risk factors for chronic postamputation pain requiring analgesia or nerve interventions: a population-based study in East Asia
Liu WC, Su FW, Su SY, Chiang CH, Yao SH, Shih CL and Eberlin KR
Postamputation pain (PAP) is underexplored in East Asian populations, with most data originating from Western countries. This study aimed to investigate the prevalence and risk factors of PAP in East Asian individuals who underwent surgical amputation, particularly those requiring subsequent analgesia or nerve interventions.
Revisiting the superficial parasternal intercostal plane block: a response to Dost
Harbell M, Seamans DP, Langley NR, Craner R and Nelson JA
Social media users' perspectives of spinal cord stimulation: an analysis of data sourced from social media
Hallo-Carrasco A, Furtado Pessoa de Mendonca L, Provenzano DA, Eldrige J, Mendoza-Chipantasi D, Encalada S and Hunt C
To identify Reddit users' viewpoints and inquiries about spinal cord stimulation (SCS) for chronic back pain using Reddit databases.
Response to the letter: Clinical outcomes for substantiation of imaging findings - the 'wasted' advantage over cadaveric studies
Balocco AL, Van Boxstael S, Hadzic A and Gautier PE
Randomized comparison between ultrasound-guided proximal and distal approaches of intercostobrachial nerve block as an adjunct to supraclavicular brachial plexus block for upper arm arteriovenous access procedures
Samerchua A, Supphapipat K, Leurcharusmee P, Lapisatepun P, Thammasupapong P and Lorsomradee S
Ultrasound-guided proximal and distal approaches of the intercostobrachial nerve (ICBN) blocks facilitate analgesia for upper arm and axillary surgery, though success rates vary and lack clinical comparison. This study compared their anesthetic and analgesic efficacy as an adjunct to the supraclavicular brachial plexus block for upper arm arteriovenous access surgery.
Axillary nerve: what anesthesiologists and pain physicians should know
Chong M, Rojas Gomez MF and Peng P
Innervation of the shoulder joint is complex and remains poorly understood among regional anesthesiologists and chronic pain specialists. Current literature supports the important contribution of the axillary nerve to the total innervation of the shoulder, as well as its blockade for perioperative pain and denervation for chronic shoulder pain. However, a description of the entire course of the axillary nerve, the corresponding optimal targets, and the sonoanatomy pertinent to pain intervention is lacking. This educational article discusses in detail the functional anatomy and sonographic identification of possible windows for axillary nerve intervention. We discuss the contribution, extent, and type of innervation the axillary nerve provides to the shoulder joint, which is often misunderstood. Ultimately, this article serves to stimulate thoughts and ideas for future research in an area where literature is scarce.
MRI genicular nerve mapping: a novel approach to sagittal genicular nerve localization
Hillery T, Hill H, Imka E, Di Lorenzo D, van Acker G and Kim C
Chronic knee pain, including postarthroplasty knee pain, is a major cause of morbidity. Radiofrequency ablation of genicular nerve branches is a treatment option. The literature to date has demonstrated and recommended consistent rhizotomy targets in the coronal and axial position of the three primary genicular nerve branches (superomedial genicular nerve, superolateral genicular nerve, inferomedial genicular nerve). The debate on genicular nerve positions focuses on the anterior-posterior courses of the nerve branches.
Radiofrequency treatments for lumbar facet joint syndrome: a systematic review and network meta-analysis
Park S, Park JH, Sokpeou N, Jang JN, Kim YU, Choi YS and Park S
Lumbar facet joint syndrome (FJS) is a common cause of chronic low back pain (LBP). Radiofrequency treatments are commonly used to treat chronic LBP-related FJS that is refractory to conservative treatment, although evidence supporting this treatment is controversial.
Continuous peripheral nerve blocks for burn management: a retrospective study of outcomes and complications in 281 burn patients
Perkins L, Pedroza G, Soghikian M, Santorelli JE, Haines LN, Box K, Lee JG, Gabriel R and Finneran JJ
There is scarce literature regarding the use of continuous peripheral nerve blocks in acute burn patients, who may be at higher risk for catheter-related complications, including infection. We sought to describe our center's experience and infection rate with continuous perineural catheters in the setting of pain management for patients suffering from burns.