Pub Date : 2024-05-01DOI: 10.1136/aap.0000000000000125corr1
BMJ Publishing Group Ltd
Brull R, Hadzic A, Reina MA, et al. Pathophysiology and Etiology of Nerve Injury Following Peripheral Nerve Blockade. Reg Anesth Pain Med 2015;40:479-490. Under the discussion section, in the anatomical considerations paragraph the article reads: A nerve can be considered a distinct organ composed
Brull R、Hadzic A、Reina MA 等：《外周神经阻滞术后神经损伤的病理生理学和病因学》。Reg Anesth Pain Med 2015;40:479-490。在讨论部分的解剖学考虑段落中，文章写道：神经可被视为一个独特的器官，由
{"title":"Correction: Pathophysiology and etiology of nerve injury following peripheral nerve blockade","authors":"BMJ Publishing Group Ltd","doi":"10.1136/aap.0000000000000125corr1","DOIUrl":"https://doi.org/10.1136/aap.0000000000000125corr1","url":null,"abstract":"Brull R, Hadzic A, Reina MA, et al. Pathophysiology and Etiology of Nerve Injury Following Peripheral Nerve Blockade. Reg Anesth Pain Med 2015;40:479-490. Under the discussion section, in the anatomical considerations paragraph the article reads: A nerve can be considered a distinct organ composed","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140889297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-30DOI: 10.1136/rapm-2024-105440
Tak Kyu Oh, In-Ae Song
Introduction We aimed to determine whether regional anesthesia (RA) has any advantages over general anesthesia (GA) in total joint arthroplasty (TJA) in terms of mortality and postoperative complications. Methods This population-based retrospective cohort study included data of adults who underwent total knee or hip arthroplasty under RA or GA between 2016 and 2021 from the National Health Insurance Service of South Korea. RA included spinal or epidural anesthesia or a combination of both. Endpoints were 30-day mortality, 90-day mortality, and postoperative complications. Propensity score (PS) matching was used for statistical analysis. Results We included 517 960 patients (RA, n=380 698; GA, n=137 262) who underwent TJA. After PS matching, 186 590 patients (93 295 in each group) were included in the final analysis. In the logistic regression analyses using the PS-matched cohort, the RA group compared with the GA group showed 31% (OR: 0.69; 95% CI, 0.60 to 0.80; p<0.001) and 22% (OR: 0.78; 95% CI, 0.72 to 0.85; p<0.001) lower 30-day and 90-day mortality rates, respectively. However, the total postoperative complication rate did not differ significantly between the two groups (p=0.105). Conclusion RA compared with GA was associated with improved 30-day and 90-day survival outcomes in patients who underwent TJA. However, the postoperative complication rate did not differ significantly. Therefore, our results should be interpreted with caution, and more well-designed future studies are needed to clarify the most appropriate type of anesthesia for TJA. Data are available upon reasonable request.
{"title":"Regional versus general anesthesia for total hip and knee arthroplasty: a nationwide retrospective cohort study","authors":"Tak Kyu Oh, In-Ae Song","doi":"10.1136/rapm-2024-105440","DOIUrl":"https://doi.org/10.1136/rapm-2024-105440","url":null,"abstract":"Introduction We aimed to determine whether regional anesthesia (RA) has any advantages over general anesthesia (GA) in total joint arthroplasty (TJA) in terms of mortality and postoperative complications. Methods This population-based retrospective cohort study included data of adults who underwent total knee or hip arthroplasty under RA or GA between 2016 and 2021 from the National Health Insurance Service of South Korea. RA included spinal or epidural anesthesia or a combination of both. Endpoints were 30-day mortality, 90-day mortality, and postoperative complications. Propensity score (PS) matching was used for statistical analysis. Results We included 517 960 patients (RA, n=380 698; GA, n=137 262) who underwent TJA. After PS matching, 186 590 patients (93 295 in each group) were included in the final analysis. In the logistic regression analyses using the PS-matched cohort, the RA group compared with the GA group showed 31% (OR: 0.69; 95% CI, 0.60 to 0.80; p<0.001) and 22% (OR: 0.78; 95% CI, 0.72 to 0.85; p<0.001) lower 30-day and 90-day mortality rates, respectively. However, the total postoperative complication rate did not differ significantly between the two groups (p=0.105). Conclusion RA compared with GA was associated with improved 30-day and 90-day survival outcomes in patients who underwent TJA. However, the postoperative complication rate did not differ significantly. Therefore, our results should be interpreted with caution, and more well-designed future studies are needed to clarify the most appropriate type of anesthesia for TJA. Data are available upon reasonable request.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140835253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-27DOI: 10.1136/rapm-2023-105162
Michael Jacob Buys, Zachary Anderson, Kimberlee Bayless, Chong Zhang, Angela P Presson, Julie Hales, Benjamin Sands Brooke
Background The USA provides medical services to its military veterans through Veterans Health Administration (VHA) medical centers. Passage of recent legislation has increased the number of veterans having VHA-paid orthopedic surgery at non-VHA facilities. Methods We conducted a retrospective cohort study among veterans who underwent orthopedic joint surgery paid for by the VHA either at the Salt Lake City VHA Medical Center (VAMC) or at non-VHA hospitals between January 2018 and December 2021. 562 patients were included in the study, of which 323 used a non-VHA hospital and 239 patients the VAMC. The number of opioid tablets prescribed at discharge, the total number prescribed by postdischarge day 90, and the number of patients still filling opioid prescriptions between 90 and 120 days after surgery were compared between groups. Results Veterans who underwent orthopedic surgery at a non-VHA hospital were prescribed more opioid tablets at discharge (median (IQR)); (40 (30–60) non-VHA vs 30 (20–47.5) VAMC, p<0.001) and in the first 90 days after surgery than patients who had surgery at the Salt Lake City VAMC (60 (40–120) vs 35 (20–60), p<0.001). Patients who had surgery at Salt Lake City VAMC were also significantly less likely to fill opioid prescriptions past 90 days after hospital discharge (OR (95% CI) 0.06 (0.01 to 0.48), p=0.007). Conclusion These results suggest that veterans who have surgery at a veterans affairs hospital with a transitional pain service are at lower risk for larger opioid prescriptions both at discharge and within 90 days after surgery as well as persistent opioid use beyond 90 days after discharge than if they have surgery at a community hospital. Data are available upon reasonable request.
{"title":"Postsurgical opioid prescribing among veterans using community care for orthopedic surgery at non-VA hospitals compared to a VA hospital with a transitional pain service: a retrospective cohort study","authors":"Michael Jacob Buys, Zachary Anderson, Kimberlee Bayless, Chong Zhang, Angela P Presson, Julie Hales, Benjamin Sands Brooke","doi":"10.1136/rapm-2023-105162","DOIUrl":"https://doi.org/10.1136/rapm-2023-105162","url":null,"abstract":"Background The USA provides medical services to its military veterans through Veterans Health Administration (VHA) medical centers. Passage of recent legislation has increased the number of veterans having VHA-paid orthopedic surgery at non-VHA facilities. Methods We conducted a retrospective cohort study among veterans who underwent orthopedic joint surgery paid for by the VHA either at the Salt Lake City VHA Medical Center (VAMC) or at non-VHA hospitals between January 2018 and December 2021. 562 patients were included in the study, of which 323 used a non-VHA hospital and 239 patients the VAMC. The number of opioid tablets prescribed at discharge, the total number prescribed by postdischarge day 90, and the number of patients still filling opioid prescriptions between 90 and 120 days after surgery were compared between groups. Results Veterans who underwent orthopedic surgery at a non-VHA hospital were prescribed more opioid tablets at discharge (median (IQR)); (40 (30–60) non-VHA vs 30 (20–47.5) VAMC, p<0.001) and in the first 90 days after surgery than patients who had surgery at the Salt Lake City VAMC (60 (40–120) vs 35 (20–60), p<0.001). Patients who had surgery at Salt Lake City VAMC were also significantly less likely to fill opioid prescriptions past 90 days after hospital discharge (OR (95% CI) 0.06 (0.01 to 0.48), p=0.007). Conclusion These results suggest that veterans who have surgery at a veterans affairs hospital with a transitional pain service are at lower risk for larger opioid prescriptions both at discharge and within 90 days after surgery as well as persistent opioid use beyond 90 days after discharge than if they have surgery at a community hospital. Data are available upon reasonable request.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140806426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-19DOI: 10.1136/rapm-2024-105292
Alexander B Stone, Andrés Zorrilla Vaca, Philipp Lirk, Philipp Gerner, Kamen Vlassakov
Introduction When used as the primary anesthetic, nerve blocks are not billed as separate procedures. In this scenario, the anesthesia start (A Start ) time should include the block procedural time. We measured how often A Start time was documented before the nerve block was placed in the preoperative area, and compared cases where a block team performed the nerve block and cases where the intraoperative anesthesia attending supervised the nerve block. We hypothesized that the involvement of a regional anesthesia team would lead to more accurate documentation of A Start . We also estimated the lost revenue due to inaccurate start time documentation. Methods The study population were patients undergoing surgery with a peripheral nerve block as the primary anesthetic. For this analysis, A Start occurring less than 10 min before the in-operating room time was defined as potentially inaccurate. Lost potential revenue was estimated by taking the difference between the documented time of local anesthetic administration and the documented A Start time. Results A total of 745 cases were analyzed. Overall, 439 cases (58%) cases were identified as having potentially inaccurate start times. There were higher rates of inaccurate A Start documentation by the block team (316/482, 65.5%) compared with blocks supervised by the in-room anesthesia attendings (123/263, 46.7%, p<0.001). Overall, the estimated loss in billable revenue during the study period was a total of $70 265. Conclusions The performance of primary regional anesthesia procedure by a block team increased the incidence of inaccurate documentation and uncaptured potential revenue. There is need for education about accurate nerve block documentation for anesthesiologists, especially when separate teams are used. No data are available.
导言：神经阻滞作为主要麻醉手段使用时，不作为单独程序计费。在这种情况下，麻醉开始（A Start）时间应包括阻滞程序时间。我们测量了在术前区域进行神经阻滞前记录 "A 开始 "时间的频率，并比较了由阻滞小组实施神经阻滞的病例和由术中麻醉主治医师监督神经阻滞的病例。我们假设，区域麻醉团队的参与将使 "开始时间 "的记录更加准确。我们还估算了因起始时间记录不准确而造成的收入损失。方法 研究对象是以周围神经阻滞作为主要麻醉方式的手术患者。在本次分析中，在手术室时间之前 10 分钟内发生的 "开始 "时间被定义为可能不准确。潜在收入损失根据记录的局麻药给药时间与记录的 A 开始时间之间的差值进行估算。结果 共分析了 745 个病例。总体而言，有 439 个病例（58%）的开始时间可能不准确。与室内麻醉主治医师监督的阻滞相比，阻滞小组记录的 A 开始时间不准确的比例更高（316/482，65.5%）（123/263，46.7%，p<0.001）。总体而言，在研究期间，估计共损失了 70 265 美元的计费收入。结论 由阻滞小组实施初级区域麻醉手术增加了不准确记录的发生率和未捕获的潜在收入。有必要对麻醉医生进行有关神经阻滞准确记录的教育，尤其是在使用独立团队的情况下。暂无数据。
{"title":"Anesthesia start time documentation accuracy where peripheral nerve block is the primary anesthetic","authors":"Alexander B Stone, Andrés Zorrilla Vaca, Philipp Lirk, Philipp Gerner, Kamen Vlassakov","doi":"10.1136/rapm-2024-105292","DOIUrl":"https://doi.org/10.1136/rapm-2024-105292","url":null,"abstract":"Introduction When used as the primary anesthetic, nerve blocks are not billed as separate procedures. In this scenario, the anesthesia start (A Start ) time should include the block procedural time. We measured how often A Start time was documented before the nerve block was placed in the preoperative area, and compared cases where a block team performed the nerve block and cases where the intraoperative anesthesia attending supervised the nerve block. We hypothesized that the involvement of a regional anesthesia team would lead to more accurate documentation of A Start . We also estimated the lost revenue due to inaccurate start time documentation. Methods The study population were patients undergoing surgery with a peripheral nerve block as the primary anesthetic. For this analysis, A Start occurring less than 10 min before the in-operating room time was defined as potentially inaccurate. Lost potential revenue was estimated by taking the difference between the documented time of local anesthetic administration and the documented A Start time. Results A total of 745 cases were analyzed. Overall, 439 cases (58%) cases were identified as having potentially inaccurate start times. There were higher rates of inaccurate A Start documentation by the block team (316/482, 65.5%) compared with blocks supervised by the in-room anesthesia attendings (123/263, 46.7%, p<0.001). Overall, the estimated loss in billable revenue during the study period was a total of $70 265. Conclusions The performance of primary regional anesthesia procedure by a block team increased the incidence of inaccurate documentation and uncaptured potential revenue. There is need for education about accurate nerve block documentation for anesthesiologists, especially when separate teams are used. No data are available.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140631096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-18DOI: 10.1136/rapm-2024-105381
Kesavan Sadacharam, James S Furstein, Steven J Staffa, Galaxy Li, Rami Karroum, Jocelyn M Booth, Eugene Kim, Suzanne M McCahan, Wallis T Muhly, Vidya Chidambaran
Introduction Although 200 000 adolescents undergo anterior cruciate ligament reconstruction (ACLR) surgery annually, no benchmarks for pediatric post-ACLR pain management exist. We created a multicenter, prospective, observational registry to describe pain practices, pain, and functional recovery after pediatric ACLR. Methods Participants (n=519; 12–17.5 years) were enrolled from 15 sites over 2 years. Data on perioperative management and surgical factors were collected. Pain/opioid use and Lysholm scores were assessed preoperatively, on postoperative day 1 (POD1), POD3, week 6, and month 6. Descriptive statistics and trends for opioid use, pain, and function are presented. Results Regional analgesia was performed in 447/519 (86%) subjects; of these, adductor canal single shot was most frequent (54%), nerve catheters placed in 24%, and perineural adjuvants used in 43%. On POD1, POD3, week 6, and month 6, survey response rates were 73%, 71%, 61%, and 45%, respectively. Over these respective time points, pain score >3/10 was reported by 64% (95% CI: 59% to 69%), 46% (95% CI: 41% to 52%), 5% (95% CI: 3% to 8%), and 3% (95% CI: 1% to 6%); the number of daily oxycodone doses used was 2.8 (SD 0.19), 1.8 (SD 0.13), 0, and 0. There was considerable variability in timing and tests for postdischarge functional assessments. Numbness and weakness were reported by 11% and 4% at week 6 (n=315) and 16% and 2% at month 6 (n=233), respectively. Conclusion We found substantial variability in the use of blocks to manage post-ACLR pain in children, with a small percentage experiencing long-term pain and neurological symptoms. Studies are needed to determine best practices for regional anesthesia and functional assessments in this patient population. Data are available upon reasonable request.
{"title":"Multisite prospective study of perioperative pain management practices for anterior cruciate ligament reconstruction in adolescents: Society for Pediatric Anesthesia Improvement Network (SPAIN) Project Report","authors":"Kesavan Sadacharam, James S Furstein, Steven J Staffa, Galaxy Li, Rami Karroum, Jocelyn M Booth, Eugene Kim, Suzanne M McCahan, Wallis T Muhly, Vidya Chidambaran","doi":"10.1136/rapm-2024-105381","DOIUrl":"https://doi.org/10.1136/rapm-2024-105381","url":null,"abstract":"Introduction Although 200 000 adolescents undergo anterior cruciate ligament reconstruction (ACLR) surgery annually, no benchmarks for pediatric post-ACLR pain management exist. We created a multicenter, prospective, observational registry to describe pain practices, pain, and functional recovery after pediatric ACLR. Methods Participants (n=519; 12–17.5 years) were enrolled from 15 sites over 2 years. Data on perioperative management and surgical factors were collected. Pain/opioid use and Lysholm scores were assessed preoperatively, on postoperative day 1 (POD1), POD3, week 6, and month 6. Descriptive statistics and trends for opioid use, pain, and function are presented. Results Regional analgesia was performed in 447/519 (86%) subjects; of these, adductor canal single shot was most frequent (54%), nerve catheters placed in 24%, and perineural adjuvants used in 43%. On POD1, POD3, week 6, and month 6, survey response rates were 73%, 71%, 61%, and 45%, respectively. Over these respective time points, pain score >3/10 was reported by 64% (95% CI: 59% to 69%), 46% (95% CI: 41% to 52%), 5% (95% CI: 3% to 8%), and 3% (95% CI: 1% to 6%); the number of daily oxycodone doses used was 2.8 (SD 0.19), 1.8 (SD 0.13), 0, and 0. There was considerable variability in timing and tests for postdischarge functional assessments. Numbness and weakness were reported by 11% and 4% at week 6 (n=315) and 16% and 2% at month 6 (n=233), respectively. Conclusion We found substantial variability in the use of blocks to manage post-ACLR pain in children, with a small percentage experiencing long-term pain and neurological symptoms. Studies are needed to determine best practices for regional anesthesia and functional assessments in this patient population. Data are available upon reasonable request.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140629797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-16DOI: 10.1136/rapm-2023-105218
Aria Lucchesi, Eric S Schwenk, Eric R Silverman
Ketamine infusions for acute pain management have received substantial interest in recent years.[1][1] While studies have been encouraging, safety concerns have prompted some state professional licensing boards to issue memorandums, limiting patient access.[2][2] Despite poor bioavailability,[3][3
{"title":"Orally administered ketamine and postoperative opioid use in colorectal surgery: a retrospective cohort study","authors":"Aria Lucchesi, Eric S Schwenk, Eric R Silverman","doi":"10.1136/rapm-2023-105218","DOIUrl":"https://doi.org/10.1136/rapm-2023-105218","url":null,"abstract":"Ketamine infusions for acute pain management have received substantial interest in recent years.[1][1] While studies have been encouraging, safety concerns have prompted some state professional licensing boards to issue memorandums, limiting patient access.[2][2] Despite poor bioavailability,[3][3","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140616084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-10DOI: 10.1136/rapm-2023-104556
Aditya Khurana, Layth Mahdi, Christopher Wie, Natalie H Strand
There is an increasing need for pain management clinicians in the USA in the midst of the opioid epidemic and aging population.[1][1] The population of adults older than 65 years is estimated to make up 20% of the US population by 2030.[2][2] Some estimates indicate that the prevalence of chronic
在阿片类药物流行和人口老龄化的背景下，美国对疼痛管理临床医生的需求日益增长。
{"title":"Age and pain: are pain management clinicians keeping up with the increasing Medicare population?","authors":"Aditya Khurana, Layth Mahdi, Christopher Wie, Natalie H Strand","doi":"10.1136/rapm-2023-104556","DOIUrl":"https://doi.org/10.1136/rapm-2023-104556","url":null,"abstract":"There is an increasing need for pain management clinicians in the USA in the midst of the opioid epidemic and aging population.[1][1] The population of adults older than 65 years is estimated to make up 20% of the US population by 2030.[2][2] Some estimates indicate that the prevalence of chronic","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140598079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-05DOI: 10.1136/rapm-2024-105345
Michael Gofeld, Kevin J Smith, Anuj Bhatia, Vladimir Djuric, Suzanne Leblang, Niv Rebhun, Ron Aginsky, Eric Miller, Brian Skoglind, Arik Hananel
Objective The objective of this study is to investigate safety and effectiveness of a fluoroscopy-guided high-intensity focused ultrasound (HIFU) system for thermal ablation of the lumbar medial branch nerves. Methods This dual center prospective cohort study enrolled 30 participants with lumbar zygapophyseal joint syndrome. Each participant previously had a positive response to either a single diagnostic analgesic block or radiofrequency ablation (RFA). The primary effectiveness outcome was individual responder rate, defined as a reduction of two points or more on the pain intensity numerical rating scale without an increase in opioid intake, or a reduction in opioid intake without an increase in pain at 6 months after the intervention. The primary safety outcome was procedure-related or device-related adverse events (AEs). Secondary outcome variables included MRI evidence of tissue ablation, Oswestry Disability Index, 12-Item Short Form Health Survey, Brief Pain Inventory, and Patient Global Impression of Change. Results The individual responder rate was 89.7% at 2 days, 89.7% at 7 days, 72.4% at 14 days, 82.1% at 30 days, 59.3% at 90 days and 82.6% at 180 days. The average Numeric Rating Scale for pain severity decreased from 7.1 at baseline to 3.0 (N=29) after 2 days, 3.0 (N=29) after 7 days, 3.1 (N=29) after 14 days, 3.2 (N=28) after 30 days, 4.3 (N=27) after 90 days, and 3.3 (N=23) after 180 days. All participants tolerated the procedure well with no significant side effects or complications. Conclusions Fluoroscopy-guided HIFU neurotomy achieved clinical responses comparable with RFA, and there were no significant device-related or procedure-related AEs. Trial registration number [NCT04129034][1]. Data are available on reasonable request. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04129034&atom=%2Frapm%2Fearly%2F2024%2F04%2F04%2Frapm-2024-105345.atom
{"title":"Fluoroscopy-guided high-intensity focused ultrasound neurotomy of the lumbar zygapophyseal joints: a prospective, open-label study","authors":"Michael Gofeld, Kevin J Smith, Anuj Bhatia, Vladimir Djuric, Suzanne Leblang, Niv Rebhun, Ron Aginsky, Eric Miller, Brian Skoglind, Arik Hananel","doi":"10.1136/rapm-2024-105345","DOIUrl":"https://doi.org/10.1136/rapm-2024-105345","url":null,"abstract":"Objective The objective of this study is to investigate safety and effectiveness of a fluoroscopy-guided high-intensity focused ultrasound (HIFU) system for thermal ablation of the lumbar medial branch nerves. Methods This dual center prospective cohort study enrolled 30 participants with lumbar zygapophyseal joint syndrome. Each participant previously had a positive response to either a single diagnostic analgesic block or radiofrequency ablation (RFA). The primary effectiveness outcome was individual responder rate, defined as a reduction of two points or more on the pain intensity numerical rating scale without an increase in opioid intake, or a reduction in opioid intake without an increase in pain at 6 months after the intervention. The primary safety outcome was procedure-related or device-related adverse events (AEs). Secondary outcome variables included MRI evidence of tissue ablation, Oswestry Disability Index, 12-Item Short Form Health Survey, Brief Pain Inventory, and Patient Global Impression of Change. Results The individual responder rate was 89.7% at 2 days, 89.7% at 7 days, 72.4% at 14 days, 82.1% at 30 days, 59.3% at 90 days and 82.6% at 180 days. The average Numeric Rating Scale for pain severity decreased from 7.1 at baseline to 3.0 (N=29) after 2 days, 3.0 (N=29) after 7 days, 3.1 (N=29) after 14 days, 3.2 (N=28) after 30 days, 4.3 (N=27) after 90 days, and 3.3 (N=23) after 180 days. All participants tolerated the procedure well with no significant side effects or complications. Conclusions Fluoroscopy-guided HIFU neurotomy achieved clinical responses comparable with RFA, and there were no significant device-related or procedure-related AEs. Trial registration number [NCT04129034][1]. Data are available on reasonable request. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04129034&atom=%2Frapm%2Fearly%2F2024%2F04%2F04%2Frapm-2024-105345.atom","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140597968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-05DOI: 10.1136/rapm-2024-105342
Marco Richard Zugaj, Oliver Gutzeit, Victoria Louise Mayer, Basem Ishak, Christoph Gumbinger, Markus Alexander Weigand, Jens Keßler
Introduction This case report documents a postoperative, incomplete sensorimotor paraparesis from thoracic vertebral body 6 (Th6) after combined anesthesia for upper abdominal surgery in a patient who had a thoracic localization of spinal epidural lipomatosis (SEL). Case presentation The patient was treated in our clinic with a thoracic epidural catheter (TEA) for perioperative analgesia during a partial duodenopancreatectomy. Paraparetic symptoms occurred 20 hours after surgery. Initial MRI did not show bleeding, infection or spinal cord damage and the neurosurgeon consultants recommended observation. The neurological examination and the third follow-up MRI on 15th postoperative day showed ventrolateral damage of the spinal cord at level Th6. It is possible that local anesthetic compressed the spinal cord in addition to the existing lipomatosis and the thoracic kyphosis. The paraparesis improved during follow-up paraplegiologic treatment. Conclusion So far, only two uncomplicated lumbar epidural catheter anesthesias have been described in patients who had a lumbar SEL. Epidural catheter anesthesia is a safe and effective method of pain control. But it is important to carefully identify and stratify patients with risk factors during the premedication visit. In patients who had kyphosis and thoracic localization of SEL, TEA may only be used after a risk–benefit assessment.
导言：本病例报告记录了一名胸椎硬膜外脂肪瘤病（SEL）患者在上腹部手术联合麻醉后，因胸椎第 6 椎体（Th6）引起的术后不完全感觉运动麻痹。病例介绍 该患者在我院接受十二指肠部分切除术，在围手术期使用胸硬膜外导管（TEA）进行镇痛。术后 20 小时出现瘫痪症状。最初的核磁共振成像未显示出血、感染或脊髓损伤，神经外科顾问建议观察。神经系统检查和术后第 15 天的第三次核磁共振随访显示，Th6 水平的脊髓腹侧受损。可能是局部麻醉剂压迫了脊髓，再加上原有的脂肪瘤和胸椎后凸。在后续的副脊髓治疗过程中，偏瘫症状有所改善。结论 到目前为止，仅有两例腰椎 SEL 患者无并发症的腰椎硬膜外导管麻醉。硬膜外导管麻醉是一种安全有效的止痛方法。但重要的是，在用药前的访视中要仔细识别有风险因素的患者并对其进行分层。对于有脊柱后凸和胸椎定位 SEL 的患者，只有在进行风险效益评估后才能使用 TEA。
{"title":"Incomplete sensorimotor paresis after upper abdominal surgery with TEA and spinal epidural lipomatosis: a case report","authors":"Marco Richard Zugaj, Oliver Gutzeit, Victoria Louise Mayer, Basem Ishak, Christoph Gumbinger, Markus Alexander Weigand, Jens Keßler","doi":"10.1136/rapm-2024-105342","DOIUrl":"https://doi.org/10.1136/rapm-2024-105342","url":null,"abstract":"Introduction This case report documents a postoperative, incomplete sensorimotor paraparesis from thoracic vertebral body 6 (Th6) after combined anesthesia for upper abdominal surgery in a patient who had a thoracic localization of spinal epidural lipomatosis (SEL). Case presentation The patient was treated in our clinic with a thoracic epidural catheter (TEA) for perioperative analgesia during a partial duodenopancreatectomy. Paraparetic symptoms occurred 20 hours after surgery. Initial MRI did not show bleeding, infection or spinal cord damage and the neurosurgeon consultants recommended observation. The neurological examination and the third follow-up MRI on 15th postoperative day showed ventrolateral damage of the spinal cord at level Th6. It is possible that local anesthetic compressed the spinal cord in addition to the existing lipomatosis and the thoracic kyphosis. The paraparesis improved during follow-up paraplegiologic treatment. Conclusion So far, only two uncomplicated lumbar epidural catheter anesthesias have been described in patients who had a lumbar SEL. Epidural catheter anesthesia is a safe and effective method of pain control. But it is important to carefully identify and stratify patients with risk factors during the premedication visit. In patients who had kyphosis and thoracic localization of SEL, TEA may only be used after a risk–benefit assessment.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140597969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-04DOI: 10.1136/rapm-2024-105340
Laura A Graham, Samantha S Illarmo, Sherry M Wren, Michelle C Odden, Seshadri C Mudumbai
Introduction Accurate data capture is integral for research and quality improvement efforts. Unfortunately, limited guidance for defining and documenting regional anesthesia has resulted in wide variation in documentation practices, even within individual hospitals, which can lead to missing and inaccurate data. This cross-sectional study sought to evaluate the performance of a natural language processing (NLP)-based algorithm developed to identify regional anesthesia within unstructured clinical notes. Methods We obtained postoperative clinical notes for all patients undergoing elective non-cardiac surgery with general anesthesia at one of six Veterans Health Administration hospitals in California between January 1, 2017, and December 31, 2022. After developing and executing our algorithm, we compared our results to a frequently used referent, the Corporate Data Warehouse structured data, to assess the completeness and accuracy of the currently available data. Measures of agreement included sensitivity, positive predictive value, false negative rate, and accuracy. Results We identified 27,713 procedures, of which 9310 (33.6%) received regional anesthesia. 96.6% of all referent regional anesthesia cases were identified in the clinic notes with a very low false negative rate and good accuracy (false negative rate=0.8%, accuracy=82.5%). Surprisingly, the clinic notes documented more than two times the number of regional anesthesia cases that were documented in the referent (algorithm n=9154 vs referent n=4606). Discussion While our algorithm identified nearly all regional anesthesia cases from the referent, it also identified more than two times as many regional anesthesia cases as the referent, raising concerns about the accuracy and completeness of regional anesthesia documentation in administrative and clinical databases. We found that NLP was a promising alternative for identifying clinical information when existing databases lack complete documentation.
{"title":"Use of natural language processing method to identify regional anesthesia from clinical notes","authors":"Laura A Graham, Samantha S Illarmo, Sherry M Wren, Michelle C Odden, Seshadri C Mudumbai","doi":"10.1136/rapm-2024-105340","DOIUrl":"https://doi.org/10.1136/rapm-2024-105340","url":null,"abstract":"Introduction Accurate data capture is integral for research and quality improvement efforts. Unfortunately, limited guidance for defining and documenting regional anesthesia has resulted in wide variation in documentation practices, even within individual hospitals, which can lead to missing and inaccurate data. This cross-sectional study sought to evaluate the performance of a natural language processing (NLP)-based algorithm developed to identify regional anesthesia within unstructured clinical notes. Methods We obtained postoperative clinical notes for all patients undergoing elective non-cardiac surgery with general anesthesia at one of six Veterans Health Administration hospitals in California between January 1, 2017, and December 31, 2022. After developing and executing our algorithm, we compared our results to a frequently used referent, the Corporate Data Warehouse structured data, to assess the completeness and accuracy of the currently available data. Measures of agreement included sensitivity, positive predictive value, false negative rate, and accuracy. Results We identified 27,713 procedures, of which 9310 (33.6%) received regional anesthesia. 96.6% of all referent regional anesthesia cases were identified in the clinic notes with a very low false negative rate and good accuracy (false negative rate=0.8%, accuracy=82.5%). Surprisingly, the clinic notes documented more than two times the number of regional anesthesia cases that were documented in the referent (algorithm n=9154 vs referent n=4606). Discussion While our algorithm identified nearly all regional anesthesia cases from the referent, it also identified more than two times as many regional anesthesia cases as the referent, raising concerns about the accuracy and completeness of regional anesthesia documentation in administrative and clinical databases. We found that NLP was a promising alternative for identifying clinical information when existing databases lack complete documentation.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140598074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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