Regional Anesthesia & Pain Medicine

Regional Anesthesia & Pain Medicine RAPM is your authoritative medical source for regional anesthesia and pain knowledge – from pediatric

✋ Can we perform hand surgery while preserving finger movement?This brief technical report describes ultrasound-guided m...
01/02/2026

✋ Can we perform hand surgery while preserving finger movement?
This brief technical report describes ultrasound-guided motor-sparing forearm blocks (MSFBs) designed to allow intraoperative motor testing during complex hand surgery.

✨ Key points:
• Sensory anesthesia while preserving finger flexion and extensión
• Enables real-time assessment of tendon repairs and transfers
• Improves surgical precision and patient satisfaction

• Requires selective distal blockade of four terminal nerves with low volumes
🔍 MSFBs offer a safe and effective alternative to proximal brachial plexus blocks in carefully selected patients undergoing specialized hand procedures.

📖 Kowa C-Y et al.

👉 Read the full article in RAPM: https://doi.org/10.1136/rapm-2025-107388

🫀 Can we safely extubate cardiac surgery patients in the operating room?A large retrospective cohort study (n=2,294) eva...
01/01/2026

🫀 Can we safely extubate cardiac surgery patients in the operating room?
A large retrospective cohort study (n=2,294) evaluated selective operating room extubation after median sternotomy in patients receiving parasternal regional analgesia.

✨ Key findings:
• No increase in reintubation rates
• No increase in NIPPV use
• Similar ICU outcomes
• Shorter hospital length of stay in patients receiving parasternal blocks

🔍 These results support the role of regional anesthesia as part of enhanced recovery pathways after cardiac surgery when applied to carefully selected patients.

📖 Christensen J et al.

👉 Read the full article in RAPM: https://doi.org/10.1136/rapm-2025-107157

📢 Can Storytelling Help Us Cope With Pain?📚 In this powerful narrative essay published in Regional Anesthesia & Pain Med...
12/31/2025

📢 Can Storytelling Help Us Cope With Pain?

📚 In this powerful narrative essay published in Regional Anesthesia & Pain Medicine, Seffrah J. Cohen reflects on childhood hospitalization, pain, and how imagination and role playing became tools for healing.

🔍 Key points:
• 🎨 Pain extends beyond physical sensation it shapes identity and memory
• 🧠 Imagination and storytelling can function as adaptive coping mechanisms
• 👧 Childhood experiences of pain influence resilience later in life
• 📖 Narrative medicine adds depth to how we understand patients’ experiences

✨ A reminder that healing is not only pharmacological, but also human.

🔗 Read the full study: https://doi.org/10.1136/rapm-2025-107436

Author:

We’re excited to share the newly released multispecialty, international consensus practice guidelines on sacroiliac join...
12/29/2025

We’re excited to share the newly released multispecialty, international consensus practice guidelines on sacroiliac joint (SIJ) complex pain in Regional Anesthesia & Pain Medicine! 🎉📘

These comprehensive guidelines synthesize current evidence on diagnosis, physical exam accuracy, intra- and extra-articular injections, sacral lateral branch RFA, minimally invasive fusion, and conservative therapies. This work supports more consistent and evidence-based SIJ care. 💡🤝
📄 Read the full guidelines: https://doi.org/10.1136/rapm-2025-107387
📊 View the infographic summary: https://doi.org/10.1136/rapm-2025-107423

📊 Do ESP Catheters Stay in the Erector Spinae Plane?In this retrospective cohort study, investigators used coincidental ...
12/28/2025

📊 Do ESP Catheters Stay in the Erector Spinae Plane?

In this retrospective cohort study, investigators used coincidental chest CT imaging to evaluate indwelling erector spinae plane (ESP) catheter position in patients with traumatic rib fractures.

✅ 16/18 catheters were found outside the ESP
✅ Most tips were intramuscular or subcutaneous
✅ Median migration distance: ~2–3 cm
❌ Skin depth documentation did not reliably reflect catheter position

💡 Why this matters:
The efficacy of continuous ESP analgesia depends on catheter position. High rates of migration may explain variable clinical outcomes and highlight the need for technique refinement.

✨ The takeaway:
ESP catheter migration is likely more common than appreciated. Prospective studies should focus on placement techniques, catheter design, and methods to reduce displacement.

🔗 Read the full study: https://doi.org/10.1136/rapm-2024-105673

👶🩺 Cesarean Delivery & Intraoperative PainA recent study examined intrapartum C-sections using labor epidurals—and the r...
12/26/2025

👶🩺 Cesarean Delivery & Intraoperative Pain

A recent study examined intrapartum C-sections using labor epidurals—and the risk of pain or conversion to general anesthesia.

🔍 Key Findings:
• 8.1% converted to general anesthesia (≈90% due to failed epidural)
• 12.9% required IV analgesic/sedative support
• Longer surgical time ↑ risk
• Emergency C-section ≠ higher risk

💡 Takeaway:
Optimizing labor epidurals and identifying risk factors early may reduce intraoperative pain and unplanned GA.

🔗 Link: https://doi.org/10.1136/rapm-2024-105388

📖 When Pain Is Rewritten by the Brain🎨 In this Pain Palette contribution, Dr. Steven L. Orebaugh uses narrative medicine...
12/26/2025

📖 When Pain Is Rewritten by the Brain

🎨 In this Pain Palette contribution, Dr. Steven L. Orebaugh uses narrative medicine to explore how pain perception can be altered by anticipation, reward, and addiction.

🔑 Key insights
• The neuroplasticity of pain processing
• The concept of “wind-up” and chronic pain
• How opioids can transform pain into perceived pleasure — and the cost that follows

💡 Why this matters
For clinicians, understanding pain requires more than physiology. Narrative perspectives deepen our insight into patient experience, opioid risk, and the ethical weight of pain treatment.

✨ The takeaway
Healing is not only procedural or pharmacologic — it also begins with listening, reflection, and understanding the human story behind pain.

🔗 Read the full paper in https://doi.org/10.1136/rapm-2024-105835

📊 Does the Popliteal Plexus Block Improve Opioid Sparing After TKA?In this randomized clinical trial (n=165), investigat...
12/24/2025

📊 Does the Popliteal Plexus Block Improve Opioid Sparing After TKA?

In this randomized clinical trial (n=165), investigators evaluated whether adding a popliteal plexus block (PPB) to a femoral triangle block (FTB) improves postoperative outcomes after total knee arthroplasty.

✅ PPB + FTB significantly reduced 24-hour opioid consumption compared with FTB or adductor canal block
✅ Median oxycodone use was reduced by 4–6 mg
✅ A higher proportion of patients required no opioids at 12 and 24 hours
❌ No differences in pain scores, mobilization, or motor strength

💡 Why this matters:
Reducing opioid exposure without impairing ambulation or muscle function remains a priority in enhanced recovery pathways after TKA.

✨ The takeaway:
Popliteal plexus block may be a valuable adjuvant for opioid-sparing analgesia after TKA, though its impact on pain scores appears limited.

🔗 Read the full study: https://doi.org/10.1136/rapm-2024-105747

🎧 NEW RAPM FOCUS DROP — Opioid Prescribing & Community Care 💊Postsurgical Opioid Prescribing Among VeteransNow streaming...
12/22/2025

🎧 NEW RAPM FOCUS DROP — Opioid Prescribing & Community Care 💊
Postsurgical Opioid Prescribing Among Veterans

Now streaming 🎙️
💡 As more Veterans receive surgical care outside VA hospitals, understanding how postoperative opioid prescribing differs across care settings is critical.

🧠 In this episode:
✔️ How postsurgical opioid prescribing patterns compare between VA and non-VA hospitals
✔️ The role of community care in orthopedic surgery for Veterans
✔️ Why these findings matter for patient safety, equity, and opioid stewardship

🎙️ Featuring:
👩‍⚕️ Dr. Alopi Patel, MD — RAPM Social Media Editor (host)
RAPM Focus
👨‍⚕️ Dr. Benjamin S. Brooke, MD, PhD — Professor of Surgery; Chief, Division of Vascular Surgery, University of Utah
RAPM Focus
👨‍⚕️ Dr. Michael “Jay” Buys, MD — Associate Professor (Clinical) of Anesthesiology, University of Utah; Chief, Acute/Transitional Pain Section, Salt Lake City VA Medical Center

🎧 Listen now on RAPM Focus
🔗 https://rapmfocusbmj.podbean.com/e/episode-46postsurgicalopioid-prescribing-amongveterans-usingcommunitycarefor-orthopedicsurgery-atnonva-hospitals-compared-toa-vahospital-with-atran/

New meta-analysis of 9,272 patients shows that peripheral nerve stimulation can provide large meaningful pain relief las...
12/21/2025

New meta-analysis of 9,272 patients shows that peripheral nerve stimulation can provide large meaningful pain relief lasting up to 24 months. These findings support broader clinical adoption and payer coverage.
FREE ARTICLE👉 https://doi.org/10.1136/rapm-2025-107160

🩺 Chronic Pain & Cardiometabolic RiskA large prospective study (452K+ patients, 13.7 yrs follow-up) found that more pain...
12/19/2025

🩺 Chronic Pain & Cardiometabolic Risk

A large prospective study (452K+ patients, 13.7 yrs follow-up) found that more pain sites = higher cardiometabolic risk.

🔍 Key Findings:
• Pain in ≥4 sites → 82% higher risk
• Pain “all over the body” → 59% higher risk
• Head + abdominal pain → highest risk

💡 Takeaway:
The distribution and burden of chronic pain may be an important marker for long-term cardiometabolic multimorbidity.

🔗 LINK: https://doi.org/10.1136/rapm-2024-105486

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