Pub Date : 2024-04-04DOI: 10.1136/rapm-2024-105424
Rajnish K Gupta, Amit Pawa
Acquiring the skills to perform ultrasound-guided regional anesthesia (UGRA) has become an integral part of anesthesiology practice in the modern era. The challenge is proficiency necessitates an in-depth understanding of three-dimensional anatomy combined with hand-eye coordination with ultrasound
{"title":"Beam me up, Scotty! Apple Vision Pro highlights how we could teleport ultrasound-guided regional anesthesia education into the future","authors":"Rajnish K Gupta, Amit Pawa","doi":"10.1136/rapm-2024-105424","DOIUrl":"https://doi.org/10.1136/rapm-2024-105424","url":null,"abstract":"Acquiring the skills to perform ultrasound-guided regional anesthesia (UGRA) has become an integral part of anesthesiology practice in the modern era. The challenge is proficiency necessitates an in-depth understanding of three-dimensional anatomy combined with hand-eye coordination with ultrasound","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":"140598262","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 : 2024-03-19DOI: 10.1136/rapm-2024-105447
Nasir Hussain, Ryan S D'Souza
There is an increasing number of meta-analyses (MAs) investigating spinal cord stimulation (SCS) for the treatment of pain; however, the quality of these has not previously been appraised. Kleppel et al [1][1] evaluate the methodological and statistical characteristics of MAs concerning SCS as a
{"title":"Finding diamonds in the rough: evaluating the quality of meta-analyses in chronic pain – an infographic","authors":"Nasir Hussain, Ryan S D'Souza","doi":"10.1136/rapm-2024-105447","DOIUrl":"https://doi.org/10.1136/rapm-2024-105447","url":null,"abstract":"There is an increasing number of meta-analyses (MAs) investigating spinal cord stimulation (SCS) for the treatment of pain; however, the quality of these has not previously been appraised. Kleppel et al [1][1] evaluate the methodological and statistical characteristics of MAs concerning SCS as a","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140170663","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 : 2024-03-19DOI: 10.1136/rapm-2024-105346
Leah Muller, Jason Pope, Paul Verrills, Erika Petersen, Jan Willem Kallewaard, Ian Gould, Dean M Karantonis
Background and objectives In spinal cord stimulation (SCS) therapy, electricity is the medication delivered to the spinal cord for pain relief. In contrast to conventional medication where dose is determined by desired therapeutic plasma concentration, there is lack of equivalent means of determining dose delivery in SCS. In open-loop (OL) SCS, due to the dynamic nature of the epidural space, the activating electric field delivered is inconsistent at the level of the dorsal columns. Recent Food and Drug Administration guidance suggests accurate and consistent therapy delivered using physiologic closed-loop control (PCLC) devices can minimize underdosage or overdosage and enhance medical care. PCLC-based evoked compound action potential (ECAP)-controlled technology provides the ability to prescribe a precise stimulation dose unique to each patient, continuously measure neural activation, and objectively inform SCS therapy optimization. Methods Neurophysiological indicator metrics of therapy dose, usage above neural activation threshold, and accuracy of SCS therapy were assessed for relationship with pain reduction in over 600 SCS patients. Results Significant relationships between objective metrics and pain relief across the patient population are shown, including first evidence for a dose-response relationship in SCS. Conclusions Higher dose, more time over ECAP threshold, and higher accuracy are associated with better outcomes across patients. There is potential to optimize individual patient outcomes based on unique objective measurable electrophysiological inputs. Data are available on reasonable request.
{"title":"First evidence of a biomarker-based dose-response relationship in chronic pain using physiological closed-loop spinal cord stimulation","authors":"Leah Muller, Jason Pope, Paul Verrills, Erika Petersen, Jan Willem Kallewaard, Ian Gould, Dean M Karantonis","doi":"10.1136/rapm-2024-105346","DOIUrl":"https://doi.org/10.1136/rapm-2024-105346","url":null,"abstract":"Background and objectives In spinal cord stimulation (SCS) therapy, electricity is the medication delivered to the spinal cord for pain relief. In contrast to conventional medication where dose is determined by desired therapeutic plasma concentration, there is lack of equivalent means of determining dose delivery in SCS. In open-loop (OL) SCS, due to the dynamic nature of the epidural space, the activating electric field delivered is inconsistent at the level of the dorsal columns. Recent Food and Drug Administration guidance suggests accurate and consistent therapy delivered using physiologic closed-loop control (PCLC) devices can minimize underdosage or overdosage and enhance medical care. PCLC-based evoked compound action potential (ECAP)-controlled technology provides the ability to prescribe a precise stimulation dose unique to each patient, continuously measure neural activation, and objectively inform SCS therapy optimization. Methods Neurophysiological indicator metrics of therapy dose, usage above neural activation threshold, and accuracy of SCS therapy were assessed for relationship with pain reduction in over 600 SCS patients. Results Significant relationships between objective metrics and pain relief across the patient population are shown, including first evidence for a dose-response relationship in SCS. Conclusions Higher dose, more time over ECAP threshold, and higher accuracy are associated with better outcomes across patients. There is potential to optimize individual patient outcomes based on unique objective measurable electrophysiological inputs. Data are available on reasonable request.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140170612","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 : 2024-03-19DOI: 10.1136/rapm-2024-105296
John-Paul B Etheridge, Roderick J Finlayson, Jan Venter, Frederik De Villiers, Jonathan P Etheridge, Reece Wakefield, Arraya Watanitanon
Background While fluoroscopic guidance is currently the imaging standard for cervical medial branch blocks (CMBBs), ultrasound guidance (USG) offers several potential safety advantages such as real-time needle visualization and the ability to detect and avoid critical soft tissue vascular or neural structures. However, no large-scale trials have examined the safety of USG for CMBB. Methods Five hundred patients undergoing 2308 individual block levels were recruited using a prospective cohort design, and blocks were performed in an outpatient office setting using an in-plane USG technique. Primary outcomes included immediate block-related complication, as well as delayed occurrences, in the following 2 weeks. Vascular structures adjacent to the target area, as well as the occurrence of vascular breach, were recorded. Results Three minor immediate complications were noted (two subcutaneous hematomas, one vasovagal reaction) comprising 0.13% of blocks (0.03% to 0.38%; 95% two-sided CI), and no delayed events were recorded (0% to 0.16%; 97.5% one-sided CI). Blood vessels were detected and avoided in 8.2% of blocks, and vascular breach was noted in 0.52% of blocks (0.27% to 0.91%; 95% two-sided CI). Conclusion When performed using an in-plane technique by experienced operators, USG CMBB was found to be safe, with rare minor immediate complications and no further adverse event reported in the following 2 weeks. Trial registration number [NCT04852393][1]. All data relevant to the study are included in the article or uploaded as supplementary information. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04852393&atom=%2Frapm%2Fearly%2F2024%2F03%2F19%2Frapm-2024-105296.atom
{"title":"Prospective evaluation of the safety of ultrasound-guided cervical medial branch blocks using the in-plane technique","authors":"John-Paul B Etheridge, Roderick J Finlayson, Jan Venter, Frederik De Villiers, Jonathan P Etheridge, Reece Wakefield, Arraya Watanitanon","doi":"10.1136/rapm-2024-105296","DOIUrl":"https://doi.org/10.1136/rapm-2024-105296","url":null,"abstract":"Background While fluoroscopic guidance is currently the imaging standard for cervical medial branch blocks (CMBBs), ultrasound guidance (USG) offers several potential safety advantages such as real-time needle visualization and the ability to detect and avoid critical soft tissue vascular or neural structures. However, no large-scale trials have examined the safety of USG for CMBB. Methods Five hundred patients undergoing 2308 individual block levels were recruited using a prospective cohort design, and blocks were performed in an outpatient office setting using an in-plane USG technique. Primary outcomes included immediate block-related complication, as well as delayed occurrences, in the following 2 weeks. Vascular structures adjacent to the target area, as well as the occurrence of vascular breach, were recorded. Results Three minor immediate complications were noted (two subcutaneous hematomas, one vasovagal reaction) comprising 0.13% of blocks (0.03% to 0.38%; 95% two-sided CI), and no delayed events were recorded (0% to 0.16%; 97.5% one-sided CI). Blood vessels were detected and avoided in 8.2% of blocks, and vascular breach was noted in 0.52% of blocks (0.27% to 0.91%; 95% two-sided CI). Conclusion When performed using an in-plane technique by experienced operators, USG CMBB was found to be safe, with rare minor immediate complications and no further adverse event reported in the following 2 weeks. Trial registration number [NCT04852393][1]. All data relevant to the study are included in the article or uploaded as supplementary information. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04852393&atom=%2Frapm%2Fearly%2F2024%2F03%2F19%2Frapm-2024-105296.atom","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140170646","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 : 2024-03-05DOI: 10.1136/rapm-2023-105229
Elisabeth Hoerner, Ottokar Stundner, Anna Seisl, Heidi Fiegl, Lukas Gasteiger
Introduction Injecting mixtures of local anesthetics with or without adjuvants is a common practise in regional and particularly obstetric anesthesia to decrease block onset time and/or augment epidural analgesia for cesarean section. While evidence on the efficacy of this practise is equivocal, little is known about its safety in terms of the pharmacologic compatibility of local anesthetics. Methods We assessed the grade of crystallization in individual mixtures of seven local anesthetics (bupivacaine, ropivacaine, lidocaine, procaine, chloroprocaine, mepivacaine, prilocaine) with or without four adjuvants (sodium bicarbonate, dexamethasone, clonidine, fentanyl) using a semiquantitative light microscopy scale (ranging from 0 to 5), repeatedly for up to 60 min and performed correlation analysis between grade of crystallization and initial solution pH. Results Of the 50 mixtures tested, 26 showed grades of crystallization ≥4 at admixture and 41 showed grades of crystallization ≥4 after 60 min. The addition of adjuvants to local anesthetic mixtures did not substantially change the grades of crystallization. Bupivacaine has a slightly lower precipitation tendency, compared with ropivacaine. A moderate relationship was found between initial pH and grade of crystallization after 15 min for the adjuvant mixtures (R=0.33, p=0.04), but not at other time points. Discussion The preparation of local anesthetic (±adjuvant) mixtures leads to high grades of crystallization, which increase over 60 min and appear independent of solution pH. The risk of mixing medications with unknown physical or chemical compatibility profiles in regional anesthesia should be critically appraised and its clinical significance elucidated in future translational research.
{"title":"Crystallization of mixtures of local anesthetics with and without select adjuvants: a semiquantitative light microscopy analysis","authors":"Elisabeth Hoerner, Ottokar Stundner, Anna Seisl, Heidi Fiegl, Lukas Gasteiger","doi":"10.1136/rapm-2023-105229","DOIUrl":"https://doi.org/10.1136/rapm-2023-105229","url":null,"abstract":"Introduction Injecting mixtures of local anesthetics with or without adjuvants is a common practise in regional and particularly obstetric anesthesia to decrease block onset time and/or augment epidural analgesia for cesarean section. While evidence on the efficacy of this practise is equivocal, little is known about its safety in terms of the pharmacologic compatibility of local anesthetics. Methods We assessed the grade of crystallization in individual mixtures of seven local anesthetics (bupivacaine, ropivacaine, lidocaine, procaine, chloroprocaine, mepivacaine, prilocaine) with or without four adjuvants (sodium bicarbonate, dexamethasone, clonidine, fentanyl) using a semiquantitative light microscopy scale (ranging from 0 to 5), repeatedly for up to 60 min and performed correlation analysis between grade of crystallization and initial solution pH. Results Of the 50 mixtures tested, 26 showed grades of crystallization ≥4 at admixture and 41 showed grades of crystallization ≥4 after 60 min. The addition of adjuvants to local anesthetic mixtures did not substantially change the grades of crystallization. Bupivacaine has a slightly lower precipitation tendency, compared with ropivacaine. A moderate relationship was found between initial pH and grade of crystallization after 15 min for the adjuvant mixtures (R=0.33, p=0.04), but not at other time points. Discussion The preparation of local anesthetic (±adjuvant) mixtures leads to high grades of crystallization, which increase over 60 min and appear independent of solution pH. The risk of mixing medications with unknown physical or chemical compatibility profiles in regional anesthesia should be critically appraised and its clinical significance elucidated in future translational research.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140034753","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 : 2024-03-01DOI: 10.1136/rapm-2024-105387
Trent Emerick, Tetyana Marshall, Thomas Jeff Martin, Doug Ririe, Eric S Schwenk
Anesthesiologists are encountering hallucinogens more frequently in surgical patients and exposure to these substances poses significant challenges because of altered physiology. In this narrative review the authors discuss a wide range of hallucinogens and psychedelics and conclude that many
{"title":"Perioperative considerations for patients exposed to hallucinogens: an infographic","authors":"Trent Emerick, Tetyana Marshall, Thomas Jeff Martin, Doug Ririe, Eric S Schwenk","doi":"10.1136/rapm-2024-105387","DOIUrl":"https://doi.org/10.1136/rapm-2024-105387","url":null,"abstract":"Anesthesiologists are encountering hallucinogens more frequently in surgical patients and exposure to these substances poses significant challenges because of altered physiology. In this narrative review the authors discuss a wide range of hallucinogens and psychedelics and conclude that many","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140017108","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 : 2024-02-21DOI: 10.1136/rapm-2023-104962
Johnathan H Goree, Nalin Payakachat, Lauren Byers, G Lawson Smith, Jarna R Shah, Kimberly E Stephens
Introduction Significant interindividual variability in spinal cord stimulation (SCS) outcomes exists. Due to its high cost and risks of complications, criteria to guide patient selection for SCS trials and their outcomes would be helpful. With increased focus on the use of patient-reported outcomes to improve care, we aim to evaluate the National Institute of Health Patient Reported Outcome Measurement Information System measures for an association with successful SCS trials in patients with persistent pain. Methods Our prospective, observational study enrolled 60 patients with persistent pain who underwent an SCS trial. Patients completed demographic and Patient Reported Outcome Measurement Information System computer adaptive test (PROMIS CAT) assessments to measure self-reported pain interference, depression, anxiety, physical functioning, and sleep disturbance at the time they presented for placement of their trial device. Results Of the 58 patients who underwent successful electrode placement, 11 had an unsuccessful trial. There were no differences in patient demographics between patients with a successful and an unsuccessful trial. Patients who had a successful SCS trial reported lower pre-trial levels of anxiety, depression, and sleep disturbance and decreased post-trial levels of depression, sleep disturbance, and pain interference. Conclusions We found that patients with high levels of depression, anxiety, and sleep disturbance using the PROMIS CAT were predictive of unsuccessful trials. In addition, we found that patients with successful SCS trials reported lower levels of these domains on PROMIS CAT administered at the end of the trial. Data are available upon reasonable request as permitted by the UAMS Institutional Review Board for data that involve human subjects.
{"title":"Impact of psychosocial factors on the success of neuromodulation treatment for patients with persistent pain","authors":"Johnathan H Goree, Nalin Payakachat, Lauren Byers, G Lawson Smith, Jarna R Shah, Kimberly E Stephens","doi":"10.1136/rapm-2023-104962","DOIUrl":"https://doi.org/10.1136/rapm-2023-104962","url":null,"abstract":"Introduction Significant interindividual variability in spinal cord stimulation (SCS) outcomes exists. Due to its high cost and risks of complications, criteria to guide patient selection for SCS trials and their outcomes would be helpful. With increased focus on the use of patient-reported outcomes to improve care, we aim to evaluate the National Institute of Health Patient Reported Outcome Measurement Information System measures for an association with successful SCS trials in patients with persistent pain. Methods Our prospective, observational study enrolled 60 patients with persistent pain who underwent an SCS trial. Patients completed demographic and Patient Reported Outcome Measurement Information System computer adaptive test (PROMIS CAT) assessments to measure self-reported pain interference, depression, anxiety, physical functioning, and sleep disturbance at the time they presented for placement of their trial device. Results Of the 58 patients who underwent successful electrode placement, 11 had an unsuccessful trial. There were no differences in patient demographics between patients with a successful and an unsuccessful trial. Patients who had a successful SCS trial reported lower pre-trial levels of anxiety, depression, and sleep disturbance and decreased post-trial levels of depression, sleep disturbance, and pain interference. Conclusions We found that patients with high levels of depression, anxiety, and sleep disturbance using the PROMIS CAT were predictive of unsuccessful trials. In addition, we found that patients with successful SCS trials reported lower levels of these domains on PROMIS CAT administered at the end of the trial. Data are available upon reasonable request as permitted by the UAMS Institutional Review Board for data that involve human subjects.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139924535","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 : 2024-02-21DOI: 10.1136/rapm-2023-105249
Donald J Kleppel, Royce Copeland, Nasir Hussain, Jay Karri, Eric Wang, Ryan S D'Souza
Background A growing number of meta-analyses (MA) have investigated the use of spinal cord stimulation (SCS) as a treatment modality for chronic pain. The quality of these MAs has not been assessed by validated appraisal tools. Objective To examine the methodological characteristics and quality of MAs related to the use of SCS for chronic pain syndromes. Evidence review An online literature search was conducted in Ovid MEDLINE(R), Ovid EMBASE, Ovid Cochrane Database of Systematic Reviews, and Scopus databases (January 1, 2000 through June 30, 2023) to identify MAs that investigated changes in pain intensity, opioid consumption, and/or physical function after SCS for the treatment of chronic pain. MA quality was assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR-2) critical appraisal tool. Findings Twenty-five MAs were appraised in the final analysis. Three were considered “high” quality, three “low” quality, and 19 “critically low” quality, per the AMSTAR-2 criteria. There was no association between the publication year and AMSTAR-2 overall quality (β 0.043; 95% CI −0.008 to 0.095; p=0.097). There was an association between the impact factor and AMSTAR-2 overall quality (β 0.108; 95% CI 0.044 to 0.172; p=0.002), such that studies published in journals with higher impact factors were associated with higher overall quality. There was no association between the effect size and AMSTAR-2 overall quality (β −0.168; 95% CI −0.518 to 0.183; p=0.320). According to our power analysis, three studies were adequately powered (>80%) to reject the null hypothesis, while the remaining studies were underpowered (<80%). Conclusions The study demonstrates a critically low AMSTAR-2 quality for most MAs published on the use of SCS for treating chronic pain. Future MAs should improve study quality by implementing the AMSTAR-2 checklist items. PROSPERO registration number CRD42023431155.
背景 越来越多的荟萃分析（MA）研究了脊髓刺激（SCS）作为慢性疼痛治疗方法的应用。这些荟萃分析的质量尚未通过有效的评估工具进行评估。目的 研究与使用 SCS 治疗慢性疼痛综合征相关的 MA 的方法学特征和质量。证据回顾 在 Ovid MEDLINE(R)、Ovid EMBASE、Ovid Cochrane 系统综述数据库和 Scopus 数据库中进行在线文献检索（2000 年 1 月 1 日至 2023 年 6 月 30 日），以确定研究 SCS 治疗慢性疼痛后疼痛强度、阿片类药物消耗量和/或身体功能变化的 MAs。采用评估系统性综述的测量工具（AMSTAR-2）关键评估工具对综述质量进行评估。结果 在最终分析中对 25 篇 MA 进行了评估。根据AMSTAR-2标准，3篇被认为质量 "高"，3篇质量 "低"，19篇质量 "极低"。发表年份与AMSTAR-2总体质量之间没有关联（β 0.043; 95% CI -0.008 to 0.095; p=0.097）。影响因子与AMSTAR-2总体质量之间存在关联（β 0.108; 95% CI 0.044 to 0.172; p=0.002），因此在影响因子较高的期刊上发表的研究与较高的总体质量相关。效应大小与 AMSTAR-2 整体质量之间没有关联（β -0.168; 95% CI -0.518 to 0.183; p=0.320）。根据我们的功率分析，三项研究的功率足以（>80%）拒绝零假设，而其余研究的功率不足（<80%）。结论 本研究表明，大多数已发表的关于使用 SCS 治疗慢性疼痛的 MAs 的 AMSTAR-2 质量极低。未来的MAs应通过实施AMSTAR-2核对表项目来提高研究质量。PROSPERO 注册号：CRD42023431155。
{"title":"Methodological and statistical characteristics of meta-analyses on spinal cord stimulation for chronic pain: a systematic review","authors":"Donald J Kleppel, Royce Copeland, Nasir Hussain, Jay Karri, Eric Wang, Ryan S D'Souza","doi":"10.1136/rapm-2023-105249","DOIUrl":"https://doi.org/10.1136/rapm-2023-105249","url":null,"abstract":"Background A growing number of meta-analyses (MA) have investigated the use of spinal cord stimulation (SCS) as a treatment modality for chronic pain. The quality of these MAs has not been assessed by validated appraisal tools. Objective To examine the methodological characteristics and quality of MAs related to the use of SCS for chronic pain syndromes. Evidence review An online literature search was conducted in Ovid MEDLINE(R), Ovid EMBASE, Ovid Cochrane Database of Systematic Reviews, and Scopus databases (January 1, 2000 through June 30, 2023) to identify MAs that investigated changes in pain intensity, opioid consumption, and/or physical function after SCS for the treatment of chronic pain. MA quality was assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR-2) critical appraisal tool. Findings Twenty-five MAs were appraised in the final analysis. Three were considered “high” quality, three “low” quality, and 19 “critically low” quality, per the AMSTAR-2 criteria. There was no association between the publication year and AMSTAR-2 overall quality (β 0.043; 95% CI −0.008 to 0.095; p=0.097). There was an association between the impact factor and AMSTAR-2 overall quality (β 0.108; 95% CI 0.044 to 0.172; p=0.002), such that studies published in journals with higher impact factors were associated with higher overall quality. There was no association between the effect size and AMSTAR-2 overall quality (β −0.168; 95% CI −0.518 to 0.183; p=0.320). According to our power analysis, three studies were adequately powered (>80%) to reject the null hypothesis, while the remaining studies were underpowered (<80%). Conclusions The study demonstrates a critically low AMSTAR-2 quality for most MAs published on the use of SCS for treating chronic pain. Future MAs should improve study quality by implementing the AMSTAR-2 checklist items. PROSPERO registration number CRD42023431155.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139924666","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 : 2024-02-21DOI: 10.1136/rapm-2023-105105
Fernando J Sánchez García, Jose Jornet Fayos, Aida Pastor del Campo, Jose Emilio LLopis Calatayud
Background Postdural puncture headache (PDPH) is a relatively common acute complication that occurs following regional anesthesia and is among the clinical features of secondary intracranial hypotension syndrome (IHS). The aim of this study was to document the radiological findings specific to PDPH with brain MRI and to determine whether these findings differed from those described in the third edition of the International Headache Society’s International Classification of Headache Disorders (ICHD-3). Methods Thirty patients who were diagnosed with PDPH based on the ICHD-3 clinical criteria were enrolled in the study and signed the informed consent form approved by our hospital ethics committee. Their symptoms were recorded and they underwent brain MRI before and after the administration of a gadolinium-based contrast agent within 48–72 hours after the onset of their orthostatic headache. Results All patients with PDPH presented with MRI features of pachymeningeal enhancement. The thickness of the pachymeningeal enhancement varied from 0.6 mm to 4.1 mm, with a mean of 1.6 mm+0.8. No cases of brain sagging were observed. 4 of the 30 patients presented with intracranial subdural fluid collections, 7 presented with pneumocephalus and 7 pituitary gland enlargement. Conclusions The radiological characteristics of IHS and PDPH are most likely the result of compensatory mechanisms in response to decreased cerebrospinal fluid pressure. The acute nature of PDPH probably causes its radiological MRI characteristics to differ from those of IHS, given that no brain sagging could be demonstrated. All data relevant to the study are included in the article or uploaded as online supplemental information.
{"title":"Brain MRI features of postdural puncture headache","authors":"Fernando J Sánchez García, Jose Jornet Fayos, Aida Pastor del Campo, Jose Emilio LLopis Calatayud","doi":"10.1136/rapm-2023-105105","DOIUrl":"https://doi.org/10.1136/rapm-2023-105105","url":null,"abstract":"Background Postdural puncture headache (PDPH) is a relatively common acute complication that occurs following regional anesthesia and is among the clinical features of secondary intracranial hypotension syndrome (IHS). The aim of this study was to document the radiological findings specific to PDPH with brain MRI and to determine whether these findings differed from those described in the third edition of the International Headache Society’s International Classification of Headache Disorders (ICHD-3). Methods Thirty patients who were diagnosed with PDPH based on the ICHD-3 clinical criteria were enrolled in the study and signed the informed consent form approved by our hospital ethics committee. Their symptoms were recorded and they underwent brain MRI before and after the administration of a gadolinium-based contrast agent within 48–72 hours after the onset of their orthostatic headache. Results All patients with PDPH presented with MRI features of pachymeningeal enhancement. The thickness of the pachymeningeal enhancement varied from 0.6 mm to 4.1 mm, with a mean of 1.6 mm+0.8. No cases of brain sagging were observed. 4 of the 30 patients presented with intracranial subdural fluid collections, 7 presented with pneumocephalus and 7 pituitary gland enlargement. Conclusions The radiological characteristics of IHS and PDPH are most likely the result of compensatory mechanisms in response to decreased cerebrospinal fluid pressure. The acute nature of PDPH probably causes its radiological MRI characteristics to differ from those of IHS, given that no brain sagging could be demonstrated. All data relevant to the study are included in the article or uploaded as online supplemental information.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139924656","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 : 2024-02-21DOI: 10.1136/rapm-2023-105154
Brian M Ilfeld, Brannon J Cha, Andrew S Qian, John J Finneran, Engy T Said, Baharin Abdullah
Pulsed shortwave (radiofrequency) therapy (PSWT) is a non-invasive, non-pharmacologic analgesic used for over 7 decades.[1 2][1] The mechanism of action involves multiple factors and is only partially understood.[3][2] Over-the-counter, lightweight, battery-operated, single-use, wearable devices
{"title":"Treating intractable postamputation pain with wearable, non-invasive, non-thermal, pulsed shortwave (radiofrequency) therapy: a randomized, double-masked, sham-controlled, crossover pilot study","authors":"Brian M Ilfeld, Brannon J Cha, Andrew S Qian, John J Finneran, Engy T Said, Baharin Abdullah","doi":"10.1136/rapm-2023-105154","DOIUrl":"https://doi.org/10.1136/rapm-2023-105154","url":null,"abstract":"Pulsed shortwave (radiofrequency) therapy (PSWT) is a non-invasive, non-pharmacologic analgesic used for over 7 decades.[1 2][1] The mechanism of action involves multiple factors and is only partially understood.[3][2] Over-the-counter, lightweight, battery-operated, single-use, wearable devices","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139924534","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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