Pub Date : 2024-02-21DOI: 10.1136/rapm-2023-105127
Amy Belba, Thibaut Vanneste, Jan Willem Kallewaard, Sander MJ van Kuijk, Marloes Gelissen, Peter Emans, Johan Bellemans, Kristof Smeets, Koen Van Boxem, Micha Sommer, Merel Kimman, Jan Van Zundert
Background Radiofrequency (RF) treatment of the genicular nerves reduces chronic knee pain in patients with osteoarthritis (OA) or persistent postsurgical pain (PPSP) after total knee arthroplasty (TKA). The objective of this study is to compare long-term outcomes of cooled and conventional RF and perform an economic evaluation. Methods The COCOGEN trial is a double-blinded, non-inferiority, pilot, randomized controlled trial that compared the effects up to 12 months of cooled and conventional RF in patients with chronic knee pain suffering from OA or PPSP after TKA following a 1:1 randomization rate. Outcomes were knee pain, functionality, quality of life, emotional health, medication use, and adverse events. A trial-based economic evaluation was performed with a 12-month societal perspective. Here, the primary outcome was the incremental costs per quality-adjusted life year (QALY). Results 41 of the 49 included patients completed the 12-month follow-up. One patient in the PPSP cooled RF group had substantial missing data at 12-month follow-up. The proportion of patients with ≥50% pain reduction at 12 months was 22.2% (4/18) in patients treated with conventional RF versus 22.7% (5/22) in patients treated with cooled RF (p>0.05). There was a statistically significant difference in the mean absolute numerical rating scale at 12 months after cooled RF and conventional RF in patients with PPSP (p=0.02). Differences between other outcomes were not statistically significant. The health economic analysis indicated that cooled RF resulted in lower costs and improved QALYs compared with conventional RF in PPSP but not in OA. There were no serious adverse events. Conclusions Both RF treatments demonstrated in approximately 22% of patients a ≥50% pain reduction at 12 months. In patients with PPSP, contrary to OA, cooled RF seems to be more effective than conventional RF. Additionally, cooled RF has in patients with PPSP, as opposed to OA, greater effectiveness at lower costs compared with conventional RF. Trial registration number [NCT03865849][1]. Data are available upon reasonable request. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03865849&atom=%2Frapm%2Fearly%2F2024%2F02%2F21%2Frapm-2023-105127.atom
{"title":"Cooled versus conventional radiofrequency treatment of the genicular nerves for chronic knee pain: 12-month and cost-effectiveness results from the multicenter COCOGEN trial","authors":"Amy Belba, Thibaut Vanneste, Jan Willem Kallewaard, Sander MJ van Kuijk, Marloes Gelissen, Peter Emans, Johan Bellemans, Kristof Smeets, Koen Van Boxem, Micha Sommer, Merel Kimman, Jan Van Zundert","doi":"10.1136/rapm-2023-105127","DOIUrl":"https://doi.org/10.1136/rapm-2023-105127","url":null,"abstract":"Background Radiofrequency (RF) treatment of the genicular nerves reduces chronic knee pain in patients with osteoarthritis (OA) or persistent postsurgical pain (PPSP) after total knee arthroplasty (TKA). The objective of this study is to compare long-term outcomes of cooled and conventional RF and perform an economic evaluation. Methods The COCOGEN trial is a double-blinded, non-inferiority, pilot, randomized controlled trial that compared the effects up to 12 months of cooled and conventional RF in patients with chronic knee pain suffering from OA or PPSP after TKA following a 1:1 randomization rate. Outcomes were knee pain, functionality, quality of life, emotional health, medication use, and adverse events. A trial-based economic evaluation was performed with a 12-month societal perspective. Here, the primary outcome was the incremental costs per quality-adjusted life year (QALY). Results 41 of the 49 included patients completed the 12-month follow-up. One patient in the PPSP cooled RF group had substantial missing data at 12-month follow-up. The proportion of patients with ≥50% pain reduction at 12 months was 22.2% (4/18) in patients treated with conventional RF versus 22.7% (5/22) in patients treated with cooled RF (p>0.05). There was a statistically significant difference in the mean absolute numerical rating scale at 12 months after cooled RF and conventional RF in patients with PPSP (p=0.02). Differences between other outcomes were not statistically significant. The health economic analysis indicated that cooled RF resulted in lower costs and improved QALYs compared with conventional RF in PPSP but not in OA. There were no serious adverse events. Conclusions Both RF treatments demonstrated in approximately 22% of patients a ≥50% pain reduction at 12 months. In patients with PPSP, contrary to OA, cooled RF seems to be more effective than conventional RF. Additionally, cooled RF has in patients with PPSP, as opposed to OA, greater effectiveness at lower costs compared with conventional RF. Trial registration number [NCT03865849][1]. Data are available upon reasonable request. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03865849&atom=%2Frapm%2Fearly%2F2024%2F02%2F21%2Frapm-2023-105127.atom","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139924664","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}
Background Phantom limb pain (PLP) frequently affects individuals with limb amputations. When PLP evolves into its chronic phase, known as chronic PLP, traditional therapies often fall short in providing sufficient relief. The optimal intervention for chronic PLP remains unclear. Objective The objectives of this network meta-analysis (NMA) were to examine the efficacy of different treatments on pain intensity for patients with chronic PLP. Evidence review We searched Medline, EMBASE, Cochrane CENTRAL, Scopus, and CINAHL EBSCO, focusing on randomized controlled trials (RCTs) that evaluated interventions such as neuromodulation, neural block, pharmacological methods, and alternative treatments. An NMA was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The primary outcome was pain score improvement, and the secondary outcomes were adverse events. Findings The NMA, incorporating 12 RCTs, indicated that neuromodulation, specifically repetitive transcranial magnetic stimulation, provided the most substantial pain improvement when compared with placebo/sham groups (mean difference=−2.9 points, 95% CI=−4.62 to –1.18; quality of evidence (QoE): moderate). Pharmacological intervention using morphine was associated with a significant increase in adverse event rate (OR=6.04, 95% CI=2.26 to 16.12; QoE: low). Conclusions The NMA suggests that neuromodulation using repetitive transcranial magnetic stimulation may be associated with significantly larger pain improvement for chronic PLP. However, the paucity of studies, varying patient characteristics across each trial, and absence of long-term results underscore the necessity for more comprehensive, large-scale RCTs. PROSPERO registration number CRD42023455949.
{"title":"Beyond traditional therapies: a network meta-analysis on the treatment efficacy for chronic phantom limb pain","authors":"Sun-Mei Chung, Jui-Chien Wang, Chung-Ren Lin, Shu-Cheng Liu, Po-Ting Wu, Fa-Chuan Kuan, Ching-Ju Fang, Yu-Kang Tu, Kai-Lan Hsu, Pei-Chun Lai, Chien-An Shih","doi":"10.1136/rapm-2023-105104","DOIUrl":"https://doi.org/10.1136/rapm-2023-105104","url":null,"abstract":"Background Phantom limb pain (PLP) frequently affects individuals with limb amputations. When PLP evolves into its chronic phase, known as chronic PLP, traditional therapies often fall short in providing sufficient relief. The optimal intervention for chronic PLP remains unclear. Objective The objectives of this network meta-analysis (NMA) were to examine the efficacy of different treatments on pain intensity for patients with chronic PLP. Evidence review We searched Medline, EMBASE, Cochrane CENTRAL, Scopus, and CINAHL EBSCO, focusing on randomized controlled trials (RCTs) that evaluated interventions such as neuromodulation, neural block, pharmacological methods, and alternative treatments. An NMA was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The primary outcome was pain score improvement, and the secondary outcomes were adverse events. Findings The NMA, incorporating 12 RCTs, indicated that neuromodulation, specifically repetitive transcranial magnetic stimulation, provided the most substantial pain improvement when compared with placebo/sham groups (mean difference=−2.9 points, 95% CI=−4.62 to –1.18; quality of evidence (QoE): moderate). Pharmacological intervention using morphine was associated with a significant increase in adverse event rate (OR=6.04, 95% CI=2.26 to 16.12; QoE: low). Conclusions The NMA suggests that neuromodulation using repetitive transcranial magnetic stimulation may be associated with significantly larger pain improvement for chronic PLP. However, the paucity of studies, varying patient characteristics across each trial, and absence of long-term results underscore the necessity for more comprehensive, large-scale RCTs. PROSPERO registration number CRD42023455949.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139924644","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-2023-105071
T Sivashanmugam, Areti Archana, P Nandhini, P Rani
Background Real-time ultrasound guidance (USG) has been applied for lower thoracic epidural access, but the more challenging mid-thoracic epidural (MTE) access remains underexplored. This report presents a technique of real-time US guidance with a novel paramedian cross view, termed “the PX view,” for securing MTE catheters, along with an outcome analysis from a retrospective case series. Methods Medical records of patients who underwent USG-MTE catheter placement with the PX view and drip infusion technique from January to December 2022 were reviewed. All catheters were placed with patients in the prone position under mild to moderate procedural sedation. The process of acquiring the PX view, in-plane needling technique, and the use of drip infusion to identify loss of resistance were detailed. The incidence of successful PX view attainment, the number of attempts, redirections, failures, and any technique-related complications were recorded. Results Fifty-one patients underwent USG-MTE catheter attempts, (42 with median sternotomy, 3 fractured ribs, 3 upper abdominal laparotomies, 2 modified radical mastectomies, and 1 thoracotomy). A satisfactory PX view was obtained in all patients, and the epidural space was identified during the first needle entry in 49 cases, resulting in a 96% first-attempt success rate. Seven patients required needle redirections, while two patients needed a second needle entry. No technique-related complications were documented. Conclusion The combination of the PX view and the drip infusion method proved effective for real-time ultrasound-guided MTE catheter placement.
{"title":"Real-time ultrasound-guided mid-thoracic epidural access using a novel paramedian cross (PX) view and drip infusion technique: a brief technical report","authors":"T Sivashanmugam, Areti Archana, P Nandhini, P Rani","doi":"10.1136/rapm-2023-105071","DOIUrl":"https://doi.org/10.1136/rapm-2023-105071","url":null,"abstract":"Background Real-time ultrasound guidance (USG) has been applied for lower thoracic epidural access, but the more challenging mid-thoracic epidural (MTE) access remains underexplored. This report presents a technique of real-time US guidance with a novel paramedian cross view, termed “the PX view,” for securing MTE catheters, along with an outcome analysis from a retrospective case series. Methods Medical records of patients who underwent USG-MTE catheter placement with the PX view and drip infusion technique from January to December 2022 were reviewed. All catheters were placed with patients in the prone position under mild to moderate procedural sedation. The process of acquiring the PX view, in-plane needling technique, and the use of drip infusion to identify loss of resistance were detailed. The incidence of successful PX view attainment, the number of attempts, redirections, failures, and any technique-related complications were recorded. Results Fifty-one patients underwent USG-MTE catheter attempts, (42 with median sternotomy, 3 fractured ribs, 3 upper abdominal laparotomies, 2 modified radical mastectomies, and 1 thoracotomy). A satisfactory PX view was obtained in all patients, and the epidural space was identified during the first needle entry in 49 cases, resulting in a 96% first-attempt success rate. Seven patients required needle redirections, while two patients needed a second needle entry. No technique-related complications were documented. Conclusion The combination of the PX view and the drip infusion method proved effective for real-time ultrasound-guided MTE catheter placement.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"52 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139924538","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-2024-105283
Brian M Ilfeld, Wendy B Abramson, Brenton Alexander, Jacklynn F Sztain, Engy T Said, Ryan C Broderick, Bryan J Sandler, Jay J Doucet, Laura M Adams, Baharin Abdullah, Brannon J Cha, John J Finneran
Background Percutaneous auricular nerve stimulation (neuromodulation) involves implanting electrodes around the ear and administering an electric current. A device is currently available within the USA cleared to treat symptoms from opioid withdrawal, and multiple reports suggest a possible postoperative analgesic effect. The current randomized controlled pilot study was undertaken to (1) determine the feasibility and optimize the protocol for a subsequent definitive clinical trial; and (2) estimate the treatment effect of auricular neuromodulation on postoperative pain and opioid consumption following two ambulatory surgical procedures. Methods Within the recovery room following cholecystectomy or hernia repair, an auricular neuromodulation device (NSS-2 Bridge, Masimo, Irvine, California, USA) was applied. Participants were randomized to 5 days of either electrical stimulation or sham in a double-blinded fashion. Results In the first 5 days, the median (IQR) pain level for active stimulation (n=15) was 0.6 (0.3–2.4) vs 2.6 (1.1–3.7) for the sham group (n=15) (p=0.041). Concurrently, the median oxycodone use for the active stimulation group was 0 mg (0–1), compared with 0 mg (0–3) for the sham group (p=0.524). Regarding the highest pain level experienced over the entire 8-day study period, only one participant (7%) who received active stimulation experienced severe pain, versus seven (47%) in those given sham (p=0.031). Conclusions Percutaneous auricular neuromodulation reduced pain scores but not opioid requirements during the initial week after cholecystectomy and hernia repair. Given the ease of application as well as a lack of systemic side effects and reported complications, a definitive clinical trial appears warranted. Trial registration number [NCT05521516][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT05521516&atom=%2Frapm%2Fearly%2F2024%2F02%2F21%2Frapm-2024-105283.atom
{"title":"Percutaneous auricular neuromodulation (nerve stimulation) for the treatment of pain following cholecystectomy and hernia repair: a randomized, double-masked, sham-controlled pilot study","authors":"Brian M Ilfeld, Wendy B Abramson, Brenton Alexander, Jacklynn F Sztain, Engy T Said, Ryan C Broderick, Bryan J Sandler, Jay J Doucet, Laura M Adams, Baharin Abdullah, Brannon J Cha, John J Finneran","doi":"10.1136/rapm-2024-105283","DOIUrl":"https://doi.org/10.1136/rapm-2024-105283","url":null,"abstract":"Background Percutaneous auricular nerve stimulation (neuromodulation) involves implanting electrodes around the ear and administering an electric current. A device is currently available within the USA cleared to treat symptoms from opioid withdrawal, and multiple reports suggest a possible postoperative analgesic effect. The current randomized controlled pilot study was undertaken to (1) determine the feasibility and optimize the protocol for a subsequent definitive clinical trial; and (2) estimate the treatment effect of auricular neuromodulation on postoperative pain and opioid consumption following two ambulatory surgical procedures. Methods Within the recovery room following cholecystectomy or hernia repair, an auricular neuromodulation device (NSS-2 Bridge, Masimo, Irvine, California, USA) was applied. Participants were randomized to 5 days of either electrical stimulation or sham in a double-blinded fashion. Results In the first 5 days, the median (IQR) pain level for active stimulation (n=15) was 0.6 (0.3–2.4) vs 2.6 (1.1–3.7) for the sham group (n=15) (p=0.041). Concurrently, the median oxycodone use for the active stimulation group was 0 mg (0–1), compared with 0 mg (0–3) for the sham group (p=0.524). Regarding the highest pain level experienced over the entire 8-day study period, only one participant (7%) who received active stimulation experienced severe pain, versus seven (47%) in those given sham (p=0.031). Conclusions Percutaneous auricular neuromodulation reduced pain scores but not opioid requirements during the initial week after cholecystectomy and hernia repair. Given the ease of application as well as a lack of systemic side effects and reported complications, a definitive clinical trial appears warranted. Trial registration number [NCT05521516][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT05521516&atom=%2Frapm%2Fearly%2F2024%2F02%2F21%2Frapm-2024-105283.atom","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139924655","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-2023-105028
Brian M Ilfeld, John J Finneran, Brenton Alexander, Wendy B Abramson, Jacklynn F Sztain, Scott T Ball, Francis B Gonzales, Baharin Abdullah, Brannon J Cha, Engy T Said
Background Percutaneous auricular nerve stimulation (neuromodulation) is an analgesic technique involving the percutaneous implantation of multiple leads at various points on/around the ear followed by the delivery of electric current using an external pulse generator. A device is currently available within the USA cleared to treat symptoms from opioid withdrawal, and multiple reports suggest a possible postoperative analgesic effect. The current randomized, controlled pilot study was undertaken to (1) determine the feasibility and optimize the protocol for a subsequent definitive clinical trial and (2) estimate the treatment effect of auricular neuromodulation on postoperative pain and opioid consumption following total knee arthroplasty. Methods Within the recovery room following primary, unilateral, total knee arthroplasty, an auricular neuromodulation device (NSS-2 Bridge, Masimo, Irvine, California, USA) was applied using three percutaneous leads and one ground electrode. Participants were randomized to 5 days of either electrical stimulation or sham stimulation in a double-masked fashion. Participants were discharged with the stimulator in situ and removed the disposable devices at home. The dual primary treatment effect outcome measures were the cumulative opioid use (oral oxycodone) and the mean of the “average” daily pain measured with the Numeric Rating Scale for the first 5 postoperative days. Results During the first five postoperative days, oxycodone consumption in participants given active stimulation (n=15) was a median (IQR) of 4 mg (2–12) vs 13 mg (5–23) in patients given sham (n=15) treatment (p=0.039). During this same period, the average pain intensity in patients given active stimulation was a median (IQR) of 2.5 (1.5–3.3) vs 4.0 (3.6–4.8) in those given sham (p=0.014). Awakenings due to pain over all eight postoperative nights in participants given active stimulation was a median (IQR) of 5 (3–8) vs 11 (4–14) in those given sham (p<0.001). No device-related localized cutaneous irritation, systemic side effects, or other adverse events were identified. Conclusions Percutaneous auricular neuromodulation reduced pain scores and opioid requirements during the initial week after total knee arthroplasty. Given the ease of application as well as the lack of systemic side effects and reported complications, a definitive clinical trial appears warranted. Trial registration number [NCT05521516][1]. Data are available on reasonable request. Deidentified patient-level data will be shared for collaborative analyses on request to BMI (email: bilfeld@health.ucsd.edu) shortly after publication. A data-sharing contract will be required. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT05521516&atom=%2Frapm%2Fearly%2F2024%2F02%2F21%2Frapm-2023-105028.atom
{"title":"Percutaneous auricular neuromodulation (nerve stimulation) for the treatment of pain following total knee arthroplasty: a randomized, double-masked, sham-controlled pilot study","authors":"Brian M Ilfeld, John J Finneran, Brenton Alexander, Wendy B Abramson, Jacklynn F Sztain, Scott T Ball, Francis B Gonzales, Baharin Abdullah, Brannon J Cha, Engy T Said","doi":"10.1136/rapm-2023-105028","DOIUrl":"https://doi.org/10.1136/rapm-2023-105028","url":null,"abstract":"Background Percutaneous auricular nerve stimulation (neuromodulation) is an analgesic technique involving the percutaneous implantation of multiple leads at various points on/around the ear followed by the delivery of electric current using an external pulse generator. A device is currently available within the USA cleared to treat symptoms from opioid withdrawal, and multiple reports suggest a possible postoperative analgesic effect. The current randomized, controlled pilot study was undertaken to (1) determine the feasibility and optimize the protocol for a subsequent definitive clinical trial and (2) estimate the treatment effect of auricular neuromodulation on postoperative pain and opioid consumption following total knee arthroplasty. Methods Within the recovery room following primary, unilateral, total knee arthroplasty, an auricular neuromodulation device (NSS-2 Bridge, Masimo, Irvine, California, USA) was applied using three percutaneous leads and one ground electrode. Participants were randomized to 5 days of either electrical stimulation or sham stimulation in a double-masked fashion. Participants were discharged with the stimulator in situ and removed the disposable devices at home. The dual primary treatment effect outcome measures were the cumulative opioid use (oral oxycodone) and the mean of the “average” daily pain measured with the Numeric Rating Scale for the first 5 postoperative days. Results During the first five postoperative days, oxycodone consumption in participants given active stimulation (n=15) was a median (IQR) of 4 mg (2–12) vs 13 mg (5–23) in patients given sham (n=15) treatment (p=0.039). During this same period, the average pain intensity in patients given active stimulation was a median (IQR) of 2.5 (1.5–3.3) vs 4.0 (3.6–4.8) in those given sham (p=0.014). Awakenings due to pain over all eight postoperative nights in participants given active stimulation was a median (IQR) of 5 (3–8) vs 11 (4–14) in those given sham (p<0.001). No device-related localized cutaneous irritation, systemic side effects, or other adverse events were identified. Conclusions Percutaneous auricular neuromodulation reduced pain scores and opioid requirements during the initial week after total knee arthroplasty. Given the ease of application as well as the lack of systemic side effects and reported complications, a definitive clinical trial appears warranted. Trial registration number [NCT05521516][1]. Data are available on reasonable request. Deidentified patient-level data will be shared for collaborative analyses on request to BMI (email: bilfeld@health.ucsd.edu) shortly after publication. A data-sharing contract will be required. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT05521516&atom=%2Frapm%2Fearly%2F2024%2F02%2F21%2Frapm-2023-105028.atom","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139924537","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-2023-105197
Ian R Carroll, Olivia Lansinger, Huy M Do, Rob Dodd, Kelly Mahaney, Daphne Li
Background Postdural puncture headache has been traditionally viewed as benign, self-limited, and highly responsive to epidural blood patching (EBP) when needed. A growing body of data from patients experiencing unintended dural puncture (UDP) in the setting of attempted labor epidural placement suggests a minority of patients will have more severe and persistent symptoms. However, the mechanisms accounting for the failure of EBP following dural puncture remain obscure. An understanding of these potential mechanisms is critical to guide management decisions in the face of severe and persistent cerebrospinal fluid (CSF) leak. Case presentation We report the case of a peripartum patient who developed a severe and persistent CSF leak unresponsive to multiple EBPs following a UDP during epidural catheter placement for labor analgesia. Lumbar MRI revealed a ventral rather than dorsal epidural fluid collection suggesting that the needle had crossed the thecal sac and punctured the ventral dura, creating a puncture site not readily accessible to blood injected in the dorsal epidural space. The location of this persistent ventral dural defect was confirmed with digital subtraction myelography, permitting a transdural surgical exploration and repair of the ventral dura with resolution of the severe intracranial hypotension. Conclusions A ventral rather than dorsal dural puncture is one mechanism that may contribute to both severe and persistent spinal CSF leak with resulting intracranial hypotension following a UDP.
{"title":"Mechanism of chronic iatrogenic CSF leak following dural puncture-ventral dural leak: case report","authors":"Ian R Carroll, Olivia Lansinger, Huy M Do, Rob Dodd, Kelly Mahaney, Daphne Li","doi":"10.1136/rapm-2023-105197","DOIUrl":"https://doi.org/10.1136/rapm-2023-105197","url":null,"abstract":"Background Postdural puncture headache has been traditionally viewed as benign, self-limited, and highly responsive to epidural blood patching (EBP) when needed. A growing body of data from patients experiencing unintended dural puncture (UDP) in the setting of attempted labor epidural placement suggests a minority of patients will have more severe and persistent symptoms. However, the mechanisms accounting for the failure of EBP following dural puncture remain obscure. An understanding of these potential mechanisms is critical to guide management decisions in the face of severe and persistent cerebrospinal fluid (CSF) leak. Case presentation We report the case of a peripartum patient who developed a severe and persistent CSF leak unresponsive to multiple EBPs following a UDP during epidural catheter placement for labor analgesia. Lumbar MRI revealed a ventral rather than dorsal epidural fluid collection suggesting that the needle had crossed the thecal sac and punctured the ventral dura, creating a puncture site not readily accessible to blood injected in the dorsal epidural space. The location of this persistent ventral dural defect was confirmed with digital subtraction myelography, permitting a transdural surgical exploration and repair of the ventral dura with resolution of the severe intracranial hypotension. Conclusions A ventral rather than dorsal dural puncture is one mechanism that may contribute to both severe and persistent spinal CSF leak with resulting intracranial hypotension following a UDP.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139924698","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 : 2024-02-02DOI: 10.1136/rapm-2023-105089
Adrian N Markewych, Tolga Suvar, Marco A Swanson, Mateusz J Graca, Timothy R Lubenow, Robert J McCarthy, Asokumar Buvanendran, David E Kurlander
Background/importance Neuropathic amputation-related pain can consist of phantom limb pain (PLP), residual limb pain (RLP), or a combination of both pathologies. Estimated of lifetime prevalence of pain and after amputation ranges between 8% and 72%. Objective This narrative review aims to summarize the surgical and non-surgical treatment options for amputation-related neuropathic pain to aid in developing optimized multidisciplinary and multimodal treatment plans that leverage multidisciplinary care. Evidence review A search of the English literature using the following keywords was performed: PLP, amputation pain, RLP. Abstract and full-text articles were evaluated for surgical treatments, medical management, regional anesthesia, peripheral block, neuromodulation, spinal cord stimulation, dorsal root ganglia, and peripheral nerve stimulation. Findings The evidence supporting most if not all interventions for PLP are inconclusive and lack high certainty. Targeted muscle reinnervation and regional peripheral nerve interface are the leading surgical treatment options for reducing neuroma formation and reducing PLP. Non-surgical options include pharmaceutical therapy, regional interventional techniques and behavioral therapies that can benefit certain patients. There is a growing evidence that neuromodulation at the spinal cord or the dorsal root ganglia and/or peripheral nerves can be an adjuvant therapy for PLP. Conclusions Multimodal approaches combining pharmacotherapy, surgery and invasive neuromodulation procedures would appear to be the most promising strategy for preventive and treating PLP and RLP. Future efforts should focus on cross-disciplinary education to increase awareness of treatment options exploring best practices for preventing pain at the time of amputation and enhancing treatment of chronic postamputation pain.
{"title":"Approaches to neuropathic amputation-related pain: narrative review of surgical, interventional, and medical treatments","authors":"Adrian N Markewych, Tolga Suvar, Marco A Swanson, Mateusz J Graca, Timothy R Lubenow, Robert J McCarthy, Asokumar Buvanendran, David E Kurlander","doi":"10.1136/rapm-2023-105089","DOIUrl":"https://doi.org/10.1136/rapm-2023-105089","url":null,"abstract":"Background/importance Neuropathic amputation-related pain can consist of phantom limb pain (PLP), residual limb pain (RLP), or a combination of both pathologies. Estimated of lifetime prevalence of pain and after amputation ranges between 8% and 72%. Objective This narrative review aims to summarize the surgical and non-surgical treatment options for amputation-related neuropathic pain to aid in developing optimized multidisciplinary and multimodal treatment plans that leverage multidisciplinary care. Evidence review A search of the English literature using the following keywords was performed: PLP, amputation pain, RLP. Abstract and full-text articles were evaluated for surgical treatments, medical management, regional anesthesia, peripheral block, neuromodulation, spinal cord stimulation, dorsal root ganglia, and peripheral nerve stimulation. Findings The evidence supporting most if not all interventions for PLP are inconclusive and lack high certainty. Targeted muscle reinnervation and regional peripheral nerve interface are the leading surgical treatment options for reducing neuroma formation and reducing PLP. Non-surgical options include pharmaceutical therapy, regional interventional techniques and behavioral therapies that can benefit certain patients. There is a growing evidence that neuromodulation at the spinal cord or the dorsal root ganglia and/or peripheral nerves can be an adjuvant therapy for PLP. Conclusions Multimodal approaches combining pharmacotherapy, surgery and invasive neuromodulation procedures would appear to be the most promising strategy for preventive and treating PLP and RLP. Future efforts should focus on cross-disciplinary education to increase awareness of treatment options exploring best practices for preventing pain at the time of amputation and enhancing treatment of chronic postamputation pain.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139661807","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}
Background Mepivacaine is an intermediate-acting local anesthetic used for spinal anesthesia in adults. Currently, there are no published dosing guidelines for spinal mepivacaine in patients under age 18. Aims The purpose of this study is to describe the clinically used doses of mepivacaine by weight and age for orthopedic surgery in pediatrics. Methods We performed a retrospective chart review of patients aged 0–18 who received mepivacaine for spinal anesthesia from 2016 to 2022. We performed a secondary analysis for patients aged 0–18 who received spinal anesthesia with bupivacaine or chloroprocaine. Results The data extraction yielded 3627 single-shot mepivacaine spinals. Patient age ranged from 5 to 18 years. Median dosage in milligrams/kilograms (mg/kg) of mepivacaine was calculated for each age group. Our analysis revealed that dosage in mg/kg decreased by patient age and began to plateau at age 15. Bupivacaine was the most common single-shot spinal agent in patients under age 10. After age 10, mepivacaine was more common. Chloroprocaine began to be used in patients older than 8 years. Conclusions We describe mepivacaine dosage as a function of age and weight in patients younger than 18 years. As age and weight increased, a lower dose of mepivacaine per kg was administered for spinal anesthesia. Data are available upon reasonable request.
{"title":"Mepivacaine dosing for spinal anesthesia in pediatric orthopedic surgery: a retrospective chart review","authors":"Michelle Carley, Miriam Sheetz, Justas Lauzadis, Haoyan Zhong, Kathryn DelPizzo","doi":"10.1136/rapm-2023-105093","DOIUrl":"https://doi.org/10.1136/rapm-2023-105093","url":null,"abstract":"Background Mepivacaine is an intermediate-acting local anesthetic used for spinal anesthesia in adults. Currently, there are no published dosing guidelines for spinal mepivacaine in patients under age 18. Aims The purpose of this study is to describe the clinically used doses of mepivacaine by weight and age for orthopedic surgery in pediatrics. Methods We performed a retrospective chart review of patients aged 0–18 who received mepivacaine for spinal anesthesia from 2016 to 2022. We performed a secondary analysis for patients aged 0–18 who received spinal anesthesia with bupivacaine or chloroprocaine. Results The data extraction yielded 3627 single-shot mepivacaine spinals. Patient age ranged from 5 to 18 years. Median dosage in milligrams/kilograms (mg/kg) of mepivacaine was calculated for each age group. Our analysis revealed that dosage in mg/kg decreased by patient age and began to plateau at age 15. Bupivacaine was the most common single-shot spinal agent in patients under age 10. After age 10, mepivacaine was more common. Chloroprocaine began to be used in patients older than 8 years. Conclusions We describe mepivacaine dosage as a function of age and weight in patients younger than 18 years. As age and weight increased, a lower dose of mepivacaine per kg was administered for spinal anesthesia. Data are available upon reasonable request.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139661775","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 : 2024-02-01DOI: 10.1136/rapm-2023-105053
Andrew Fuqua, Ajay Premkumar, Prathap Jayaram, Casey Wagner
Background and objectives Genicular nerve radiofrequency ablation (GNRFA) is an emerging procedure used to relieve pain from severe knee osteoarthritis. While there have been rare reports of significant complications, their incidence has not been well established. The objective of this study was to examine complication rates at 30 and 90 days post treatment as well as characterize opioid-prescribing patterns before and after treatment. Methods A large national database was queried to identify patients undergoing GNRFA from 2015 to 2022 and matched to control cohorts composed of patients receiving either intra-articular corticosteroid (CSI) or hyaluronic acid injection (HAI) of the knee. Complication rates at 30 and 90 days were analyzed. Opioid utilization was assessed in the 6 months before and after treatment. Results Rates of infection (0.1%, CI 0.02% to 0.5% vs 0.2%, CI 0.05% to 0.6%), septic arthritis (<0.1%, CI 0.003% to 0.4% vs 0.1%, CI 0.02% to 0.5%), deep vein thrombosis (2.0%, CI 1.3% to 2.7% vs 1.6%, CI 1.0% to 2.2%), pulmonary embolism (1.2%, CI 0.6% to 1.7% vs 1.3%, CI 1.1% to 2.5%), bleeding (<0.1%, CI 0.003% to 0.4% vs 0%, CI 0% to 0.3%), seroma (<0.1%, CI 0.003% to 0.4% vs 0.2%, CI 0.05% to 0.6%), nerve injury (0%, CI 0% to 0.3% vs 0%, CI 0% to 0.3%) and thermal injury (0%, CI 0% to 0.3% vs 0%, CI 0% to 0.3%) were not different between CSI and GNRFA cohorts at 30 days. Rate of swelling was significantly greater in the GNRFA cohort (9.4%, CI 7.6% to 10.4% vs 6.4%, CI 4.8% to 7.2%, p=0.003) at 30 days. At 90 days, rates of septic arthritis (0.1%, CI 0.02% to 0.5% vs 0.3%, CI 0.08% to 0.7%), deep vein thrombosis (3.1%, CI 2.1% to 3.8% vs 3.1%, CI 2.2% to 3.9%), pulmonary embolism (1.5%, CI 0.9% to 2.1% vs 1.8%, CI 1.2% to 2.5%), and nerve injury (0%, CI 0% to 0.3% vs <0.1%, CI 0.003% to 0.4%) were not significantly different. Between HAI versus GNRFA cohorts, no significant differences were seen in rates of infection (0.3%, CI 0.08% to 0.07% vs 0.7%, CI 0.3% to 1.2%), septic arthritis (0.2%, CI 0.05% to 0.6% vs 0.4%, CI 0.2% to 0.9%), deep vein thrombosis (2.0%, CI 1.3% to 2.7% vs 1.9%, CI 1.2% to 2.7%), pulmonary embolism (1.5%, CI 0.9% to 2.2% vs 1.7%, CI 1.1% to 2.5%), bleeding (0.1%, CI 0.02% to 0.5% vs 0.2%, CI 0.05% to 0.6%), seroma (<0.1%, CI 0.03% to 0.4% vs 0%, CI 0% to 0.3%), nerve injury (0%, CI 0% to 0.3% vs 0%, CI 0% to 0.3%), swelling (14.0%, CI 11.6% to 15.1% vs 12.0%, CI 10.3% to 13.6%), and thermal injury (<0.1%, CI 0.03% to 0.4% vs <0.01%, CI 0.3% to 0.4%) at 30 days. Rates of infection (0.7%, CI 0.3% to 1.2% vs 1.4%, CI 0.9% to 2.1%), septic arthritis (0.3%, CI 0.1% to 0.8% vs 0.5%, CI 0.2% to 1.1%), deep vein thrombosis (3.6%, CI 2.6% to 4.4% vs 3.1%, CI 2.2% to 4.0%), pulmonary embolism (2.3%, CI 1.5% to 3.0% vs 2.1%, CI 1.4% to 3.0%) and nerve injury (0%, CI 0% to 0.3% vs 0.1%, CI 0.02% to 0.5%) were not significantly different at 90 days. There were no significant differences in level of pretreatment opioid uti
背景和目的 膝盖神经射频消融术（GNRFA）是一种新兴的手术，用于缓解严重膝骨关节炎引起的疼痛。虽然很少有关于严重并发症的报道，但并发症的发生率尚未得到很好的证实。本研究旨在检查治疗后 30 天和 90 天的并发症发生率，以及治疗前后阿片类药物处方模式的特点。方法 通过查询大型国家数据库，确定 2015 年至 2022 年期间接受 GNRFA 的患者，并与接受膝关节内皮质类固醇 (CSI) 或透明质酸注射 (HAI) 的患者组成的对照组进行匹配。对 30 天和 90 天的并发症发生率进行了分析。对治疗前后 6 个月的阿片类药物使用情况进行了评估。结果 感染率（0.1%，CI 0.02% 至 0.5% vs 0.2%，CI 0.05% 至 0.6%）、化脓性关节炎（<0.1%，CI 0.003% 至 0.4% vs 0.1%，CI 0.02% 至 0.5%）、深静脉血栓（2.0%，CI 1.3%至2.7% vs 1.6%，CI 1.0%至2.2%）、肺栓塞（1.2%，CI 0.6%至1.7% vs 1.3%，CI 1.1%至2.30天时，CSI队列和GNRFA队列之间在出血（<0.1%，CI 0.003% 至 0.4% vs 0%，CI 0% 至 0.3%）、血清肿（<0.1%，CI 0.003% 至 0.4% vs 0.2%，CI 0.05% 至 0.6%）、神经损伤（0%，CI 0% 至 0.3% vs 0%，CI 0% 至 0.3%）和热损伤（0%，CI 0% 至 0.3% vs 0%，CI 0% 至 0.3%）方面没有差异。30 天时，GNRFA 组的肿胀率明显更高（9.4%，CI 7.6% 至 10.4% vs 6.4%，CI 4.8% 至 7.2%，P=0.003）。90天时，脓毒性关节炎（0.1%，CI为0.02%至0.5% vs 0.3%，CI为0.08%至0.7%）、深静脉血栓（3.1%，CI为2.1%至3.8% vs 3.1%，CI为2.2%至3.9%）、肺栓塞（1.5%，CI 0.9% 至 2.1% vs 1.8%，CI 1.2% 至 2.5%）和神经损伤（0%，CI 0% 至 0.3% vs <0.1%，CI 0.003% 至 0.4%）无显著差异。在 HAI 与 GNRFA 队列之间，感染率（0.3%，CI 0.08% 至 0.07% vs 0.7%，CI 0.3% 至 1.2%）、化脓性关节炎（0.2%，CI 0.05% 至 0.6% vs 0.4%，CI 0.2% 至 0.9%）、深静脉血栓（2.0%，CI 1.3% 至 2.7% vs 1.9%，CI 1.2% 至 2.7%）、肺栓塞（1.5%，CI 0.9% 至 2.2% vs 1.7%，CI 1.1%至2.5%）、出血（0.1%，CI为0.02%至0.5% vs 0.2%，CI为0.05%至0.6%）、血清肿（<0.1%，CI为0.03%至0.4% vs 0%，CI为0%至0.3%）、神经损伤（0%，CI为0%至0.30天时，肿胀（14.0%，CI 11.6% 至 15.1% vs 12.0%，CI 10.3% 至 13.6%）和热损伤（<0.1%，CI 0.03% 至 0.4% vs <0.01%，CI 0.3% 至 0.4%）。感染（0.7%，CI 0.3%至1.2% vs 1.4%，CI 0.9%至2.1%）、化脓性关节炎（0.3%，CI 0.1%至0.8% vs 0.5%，CI 0.2%至1.1%）、深静脉血栓（3.6%，CI 2.6%至4.4% vs 3.1%，CI 2.90天时，深静脉血栓（3.6%，CI值为2.6%至4.4% vs 3.1%，CI值为2.2%至4.0%）、肺栓塞（2.3%，CI值为1.5%至3.0% vs 2.1%，CI值为1.4%至3.0%）和神经损伤（0%，CI值为0%至0.3% vs 0.1%，CI值为0.02%至0.5%）无显著差异。虽然GNRFA队列中平均每日吗啡当量的总体消耗量更大，但治疗前阿片类药物的使用水平没有明显差异。与对照组相比，既往未使用过阿片类药物的患者在消融术后前30天的阿片类药物使用量明显增加。在既往使用过阿片类药物或长期使用阿片类药物的患者中，所有治疗组在 6 个月后的阿片类药物需求量普遍减少，在减少阿片类药物消耗量方面没有明显优越的治疗方法。结论 我们的研究表明，尽管静脉血栓栓塞和化脓性关节炎等重大不良事件可能极少发生，但 GNRFA 具有与关节内注射相似的安全性。虽然与关节内注射相比，消融术后 30 天内阿片类药物的使用量普遍增加，但在消融术组和对照组中，曾使用过阿片类药物的患者在 6 个月时阿片类药物的用量减少情况相似。如有合理要求，可提供相关数据。所有数据均通过 IBM（现为 Merative）Marketscan 研究数据库获得。
{"title":"Complications and opioid-prescribing patterns following genicular nerve radiofrequency ablation versus intra-articular injection: a matched cohort study","authors":"Andrew Fuqua, Ajay Premkumar, Prathap Jayaram, Casey Wagner","doi":"10.1136/rapm-2023-105053","DOIUrl":"https://doi.org/10.1136/rapm-2023-105053","url":null,"abstract":"Background and objectives Genicular nerve radiofrequency ablation (GNRFA) is an emerging procedure used to relieve pain from severe knee osteoarthritis. While there have been rare reports of significant complications, their incidence has not been well established. The objective of this study was to examine complication rates at 30 and 90 days post treatment as well as characterize opioid-prescribing patterns before and after treatment. Methods A large national database was queried to identify patients undergoing GNRFA from 2015 to 2022 and matched to control cohorts composed of patients receiving either intra-articular corticosteroid (CSI) or hyaluronic acid injection (HAI) of the knee. Complication rates at 30 and 90 days were analyzed. Opioid utilization was assessed in the 6 months before and after treatment. Results Rates of infection (0.1%, CI 0.02% to 0.5% vs 0.2%, CI 0.05% to 0.6%), septic arthritis (<0.1%, CI 0.003% to 0.4% vs 0.1%, CI 0.02% to 0.5%), deep vein thrombosis (2.0%, CI 1.3% to 2.7% vs 1.6%, CI 1.0% to 2.2%), pulmonary embolism (1.2%, CI 0.6% to 1.7% vs 1.3%, CI 1.1% to 2.5%), bleeding (<0.1%, CI 0.003% to 0.4% vs 0%, CI 0% to 0.3%), seroma (<0.1%, CI 0.003% to 0.4% vs 0.2%, CI 0.05% to 0.6%), nerve injury (0%, CI 0% to 0.3% vs 0%, CI 0% to 0.3%) and thermal injury (0%, CI 0% to 0.3% vs 0%, CI 0% to 0.3%) were not different between CSI and GNRFA cohorts at 30 days. Rate of swelling was significantly greater in the GNRFA cohort (9.4%, CI 7.6% to 10.4% vs 6.4%, CI 4.8% to 7.2%, p=0.003) at 30 days. At 90 days, rates of septic arthritis (0.1%, CI 0.02% to 0.5% vs 0.3%, CI 0.08% to 0.7%), deep vein thrombosis (3.1%, CI 2.1% to 3.8% vs 3.1%, CI 2.2% to 3.9%), pulmonary embolism (1.5%, CI 0.9% to 2.1% vs 1.8%, CI 1.2% to 2.5%), and nerve injury (0%, CI 0% to 0.3% vs <0.1%, CI 0.003% to 0.4%) were not significantly different. Between HAI versus GNRFA cohorts, no significant differences were seen in rates of infection (0.3%, CI 0.08% to 0.07% vs 0.7%, CI 0.3% to 1.2%), septic arthritis (0.2%, CI 0.05% to 0.6% vs 0.4%, CI 0.2% to 0.9%), deep vein thrombosis (2.0%, CI 1.3% to 2.7% vs 1.9%, CI 1.2% to 2.7%), pulmonary embolism (1.5%, CI 0.9% to 2.2% vs 1.7%, CI 1.1% to 2.5%), bleeding (0.1%, CI 0.02% to 0.5% vs 0.2%, CI 0.05% to 0.6%), seroma (<0.1%, CI 0.03% to 0.4% vs 0%, CI 0% to 0.3%), nerve injury (0%, CI 0% to 0.3% vs 0%, CI 0% to 0.3%), swelling (14.0%, CI 11.6% to 15.1% vs 12.0%, CI 10.3% to 13.6%), and thermal injury (<0.1%, CI 0.03% to 0.4% vs <0.01%, CI 0.3% to 0.4%) at 30 days. Rates of infection (0.7%, CI 0.3% to 1.2% vs 1.4%, CI 0.9% to 2.1%), septic arthritis (0.3%, CI 0.1% to 0.8% vs 0.5%, CI 0.2% to 1.1%), deep vein thrombosis (3.6%, CI 2.6% to 4.4% vs 3.1%, CI 2.2% to 4.0%), pulmonary embolism (2.3%, CI 1.5% to 3.0% vs 2.1%, CI 1.4% to 3.0%) and nerve injury (0%, CI 0% to 0.3% vs 0.1%, CI 0.02% to 0.5%) were not significantly different at 90 days. There were no significant differences in level of pretreatment opioid uti","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"286 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139658836","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 : 2024-01-25DOI: 10.1136/rapm-2023-105164
Reem Farjo, Hsou-Mei Hu, Jennifer F Waljee, Michael J Englesbe, Chad M Brummett, Mark C Bicket
Introduction While identifying opioid prescriptions in claims data has been instrumental in informing best practises, studies have not evaluated whether certain methods of identifying opioid prescriptions yield better results. We compared three common approaches to identify opioid prescriptions in large, nationally representative databases. Methods We performed a retrospective cohort study, analyzing MarketScan, Optum, and Medicare claims to compare three methods of opioid classification: claims database-specific classifications, National Drug Codes (NDC) from the Centers for Disease Control and Prevention (CDC), or NDC from Overdose Prevention Engagement Network (OPEN). The primary outcome was discrimination by area under the curve (AUC), with secondary outcomes including the number of opioid prescriptions identified by experts but not identified by each method. Results All methods had high discrimination (AUC>0.99). For MarketScan (n=70,162,157), prescriptions that were not identified totalled 42,068 (0.06%) for the CDC list, 2,067,613 (2.9%) for database-specific categories, and 0 (0%) for the OPEN list. For Optum (n=61,554,852), opioid prescriptions not identified totalled 9,774 (0.02%) for the CDC list, 83,700 (0.14%) for database-specific categories, and 0 (0%) for the OPEN list. In Medicare claims (n=92,781,299), the number of opioid prescriptions not identified totalled 8,694 (0.01%) for the CDC file and 0 (0%) for the OPEN list. Discussion This analysis found that identifying opioid prescriptions using methods from CDC and OPEN were similar and superior to prespecified database-specific categories. Overall, this study shows the importance of carefully selecting the approach to identify opioid prescriptions when investigating claims data. Data may be obtained from a third party and are not publicly available. All data relevant to the study are included in the article or uploaded as supplementary information. Data sets in this study (MarketScan, Optum, and Medicare claims) are available through those third parties.
{"title":"Comparison of methods to identify individuals prescribed opioid analgesics for pain","authors":"Reem Farjo, Hsou-Mei Hu, Jennifer F Waljee, Michael J Englesbe, Chad M Brummett, Mark C Bicket","doi":"10.1136/rapm-2023-105164","DOIUrl":"https://doi.org/10.1136/rapm-2023-105164","url":null,"abstract":"Introduction While identifying opioid prescriptions in claims data has been instrumental in informing best practises, studies have not evaluated whether certain methods of identifying opioid prescriptions yield better results. We compared three common approaches to identify opioid prescriptions in large, nationally representative databases. Methods We performed a retrospective cohort study, analyzing MarketScan, Optum, and Medicare claims to compare three methods of opioid classification: claims database-specific classifications, National Drug Codes (NDC) from the Centers for Disease Control and Prevention (CDC), or NDC from Overdose Prevention Engagement Network (OPEN). The primary outcome was discrimination by area under the curve (AUC), with secondary outcomes including the number of opioid prescriptions identified by experts but not identified by each method. Results All methods had high discrimination (AUC>0.99). For MarketScan (n=70,162,157), prescriptions that were not identified totalled 42,068 (0.06%) for the CDC list, 2,067,613 (2.9%) for database-specific categories, and 0 (0%) for the OPEN list. For Optum (n=61,554,852), opioid prescriptions not identified totalled 9,774 (0.02%) for the CDC list, 83,700 (0.14%) for database-specific categories, and 0 (0%) for the OPEN list. In Medicare claims (n=92,781,299), the number of opioid prescriptions not identified totalled 8,694 (0.01%) for the CDC file and 0 (0%) for the OPEN list. Discussion This analysis found that identifying opioid prescriptions using methods from CDC and OPEN were similar and superior to prespecified database-specific categories. Overall, this study shows the importance of carefully selecting the approach to identify opioid prescriptions when investigating claims data. Data may be obtained from a third party and are not publicly available. All data relevant to the study are included in the article or uploaded as supplementary information. Data sets in this study (MarketScan, Optum, and Medicare claims) are available through those third parties.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139556919","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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