We read with profound interest the meta-analysis by Hussain et al comparing the analgesic efficacy of single-shot and continuous adductor canal block (ACB) in the context of total knee arthroplasty (TKA).[1][1] In their study, the authors found no significant differences in postoperative analgesia
{"title":"Subsartorial canal catheter: a reliable catheter placement technique for continuous proximal adductor canal block","authors":"Takashi Fujino, Takayuki Yoshida, Izumi Kawagoe, Tatsuo Nakamoto","doi":"10.1136/rapm-2023-105193","DOIUrl":"https://doi.org/10.1136/rapm-2023-105193","url":null,"abstract":"We read with profound interest the meta-analysis by Hussain et al comparing the analgesic efficacy of single-shot and continuous adductor canal block (ACB) in the context of total knee arthroplasty (TKA).[1][1] In their study, the authors found no significant differences in postoperative analgesia","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139071068","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 : 2023-12-30DOI: 10.1136/rapm-2023-105149
Yong Seon Choi, Jaewon Jang, Ha Yan Kim, Bora Lee, Eun Jung Kim, Hei Jin Yoon, Jongyun Lee, Hye Jin Kim
Introduction The present study aimed to compare the correlation and agreement of epidural depth estimation using ultrasound in the paramedian sagittal oblique (PSO) versus the transverse median (TM) plane relative to the actual epidural depth observed during midline epidural punctures in children with scoliosis. Methods In this prospective observational study, we enrolled 55 children aged 3–14 years with thoracolumbar scoliosis (Cobb angle >10°) requesting postoperative epidural analgesia. Ultrasound imaging was performed to estimate the distance from the skin to the epidural space in the bilateral PSO and TM planes. An anesthesiologist performed midline epidural puncture and measured the actual epidural depth from the skin to the epidural space. The correlation and degree of agreement between the ultrasound-estimated and actual epidural depths were investigated using Pearson’s and concordance correlation coefficients. The image quality of the ligamentum flavum and posterior dura mater was compared. Results In the PSO view, where the larger of the two measurements from both sides was used, both Pearson’s and concordance correlation coefficients for comparing the actual epidural and ultrasound-estimated depths were significantly higher than those in the TM view (0.964 vs 0.930, p value=0.002; 0.952 vs 0.892, p value=0.004, respectively). The ligamentum flavum-posterior dura mater unit was more easily distinguished in the PSO view than in the TM view (72.7% vs 38.2%, p value<0.001). Conclusions The PSO view can be a reliable guide to facilitate epidural puncture in children with scoliosis with better visualization. Trial registration number [NCT04877964][1]. Data are available upon reasonable request. The data that support the findings of this study are available on request from the corresponding author. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04877964&atom=%2Frapm%2Fearly%2F2023%2F12%2F30%2Frapm-2023-105149.atom
{"title":"Ultrasound estimates of the epidural depth in the paramedian sagittal oblique and transverse median planes: the correlation between estimated and actual depth to the epidural space in children with scoliosis","authors":"Yong Seon Choi, Jaewon Jang, Ha Yan Kim, Bora Lee, Eun Jung Kim, Hei Jin Yoon, Jongyun Lee, Hye Jin Kim","doi":"10.1136/rapm-2023-105149","DOIUrl":"https://doi.org/10.1136/rapm-2023-105149","url":null,"abstract":"Introduction The present study aimed to compare the correlation and agreement of epidural depth estimation using ultrasound in the paramedian sagittal oblique (PSO) versus the transverse median (TM) plane relative to the actual epidural depth observed during midline epidural punctures in children with scoliosis. Methods In this prospective observational study, we enrolled 55 children aged 3–14 years with thoracolumbar scoliosis (Cobb angle >10°) requesting postoperative epidural analgesia. Ultrasound imaging was performed to estimate the distance from the skin to the epidural space in the bilateral PSO and TM planes. An anesthesiologist performed midline epidural puncture and measured the actual epidural depth from the skin to the epidural space. The correlation and degree of agreement between the ultrasound-estimated and actual epidural depths were investigated using Pearson’s and concordance correlation coefficients. The image quality of the ligamentum flavum and posterior dura mater was compared. Results In the PSO view, where the larger of the two measurements from both sides was used, both Pearson’s and concordance correlation coefficients for comparing the actual epidural and ultrasound-estimated depths were significantly higher than those in the TM view (0.964 vs 0.930, p value=0.002; 0.952 vs 0.892, p value=0.004, respectively). The ligamentum flavum-posterior dura mater unit was more easily distinguished in the PSO view than in the TM view (72.7% vs 38.2%, p value<0.001). Conclusions The PSO view can be a reliable guide to facilitate epidural puncture in children with scoliosis with better visualization. Trial registration number [NCT04877964][1]. Data are available upon reasonable request. The data that support the findings of this study are available on request from the corresponding author. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04877964&atom=%2Frapm%2Fearly%2F2023%2F12%2F30%2Frapm-2023-105149.atom","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139070075","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 : 2023-12-21DOI: 10.1136/rapm-2023-104864
Mirjam Ruth Schieber, Ann-Kristin Schubert, Wakiko Hubner, Thomas Volk
Introduction Anticoagulation guidelines were developed to reduce the potential risk of epidural bleeding following neuraxial anesthesia. However, the influence of antithrombotic medication on size of spinal epidural hematoma and neurological outcome is unclear. Therefore, our aim was to analyze whether there is a correlation. Methods The study was registered at Prospero (CRD42021285833). A systematic search in MEDLINE, EMBASE, CENTRAL, Web of Science and Google Scholar was conducted in August 2023 for studies reporting spinal epidural hematoma following neuraxial anesthesia. Primary endpoints were segmental extension and neurological outcome. Secondary endpoints were age, sex, body mass index, predisposition, American Society of Anesthesiologists physical status, complicated puncture, multiple punctures, bloody puncture, successful puncture, catheter usage, needle size and worst neurological deficit before treatment. Prespecified multivariate regression and propensity score matching was performed. Publications reporting on more than one patient were critically appraised. Results A total of 345 cases reported in 304 publications were included. Size of hematoma was not significantly different (antithrombotic medication: OR 0.11, 95% CI (−0.67 to 0.89), p=0.78, ‘non-guideline adherent’ for puncture/removal: OR 0.13, 95% CI (−0.92 to 1.18), p=0.81). Patients receiving antithrombotic medication were more likely to have persistent neurological deficit (OR 2.00, 95% CI 1.24 to 3.23), p<0.01). Significance persisted after propensity score matching (p=0.04). Patients with non-guideline adherence had a 3.42 higher chance of persistent neurological deficit (95% CI 1.71 to 6.86, p<0.001). Discussion Antithrombotic medication is not significantly associated with hematoma size; however, the use of antithrombotic medication doubled the risk for persistent neurological deficit after spinal epidural hematoma. All data relevant to the study are included in the article or uploaded as online supplemental information.
导言 制定抗凝指南是为了降低神经轴麻醉后硬膜外出血的潜在风险。然而，抗血栓药物对脊髓硬膜外血肿大小和神经功能预后的影响尚不明确。因此，我们的目的是分析两者之间是否存在相关性。方法 该研究已在 Prospero（CRD42021285833）注册。2023 年 8 月，我们在 MEDLINE、EMBASE、CENTRAL、Web of Science 和 Google Scholar 中进行了系统性检索，以了解有关神经轴麻醉后脊髓硬膜外血肿的研究。主要终点是节段性扩展和神经功能结果。次要终点为年龄、性别、体重指数、易感性、美国麻醉医师协会身体状况、复杂穿刺、多次穿刺、血性穿刺、成功穿刺、导管使用、针头大小和治疗前最严重的神经功能缺损。进行了预设多变量回归和倾向得分匹配。对报道一名以上患者的文献进行了严格评估。结果 共纳入了 304 篇文献中报道的 345 个病例。血肿大小无明显差异（抗血栓药物：OR 0.11，95% C.D.）：OR 0.11，95% CI (-0.67 to 0.89)，p=0.78，"不遵守指南 "穿刺/清除：OR 0.13，95% CI (-0.92 to 1.18)，p=0.81）。接受抗血栓药物治疗的患者更有可能出现持续性神经功能缺损（OR 2.00，95% CI 1.24 至 3.23），P<0.01）。倾向得分匹配后，显著性依然存在（P=0.04）。未遵守指南的患者出现持续性神经功能缺损的几率要高出 3.42（95% CI 1.71 至 6.86，p<0.001）。讨论 抗血栓药物与血肿大小无明显关系；但使用抗血栓药物会使脊髓硬膜外血肿后出现持续性神经功能缺损的风险增加一倍。与该研究相关的所有数据均包含在文章中或作为在线补充信息上传。
{"title":"Influence of antithrombotic medication on size and neurological outcome of spinal epidural hematoma after neuraxial anesthesia: a systematic review","authors":"Mirjam Ruth Schieber, Ann-Kristin Schubert, Wakiko Hubner, Thomas Volk","doi":"10.1136/rapm-2023-104864","DOIUrl":"https://doi.org/10.1136/rapm-2023-104864","url":null,"abstract":"Introduction Anticoagulation guidelines were developed to reduce the potential risk of epidural bleeding following neuraxial anesthesia. However, the influence of antithrombotic medication on size of spinal epidural hematoma and neurological outcome is unclear. Therefore, our aim was to analyze whether there is a correlation. Methods The study was registered at Prospero (CRD42021285833). A systematic search in MEDLINE, EMBASE, CENTRAL, Web of Science and Google Scholar was conducted in August 2023 for studies reporting spinal epidural hematoma following neuraxial anesthesia. Primary endpoints were segmental extension and neurological outcome. Secondary endpoints were age, sex, body mass index, predisposition, American Society of Anesthesiologists physical status, complicated puncture, multiple punctures, bloody puncture, successful puncture, catheter usage, needle size and worst neurological deficit before treatment. Prespecified multivariate regression and propensity score matching was performed. Publications reporting on more than one patient were critically appraised. Results A total of 345 cases reported in 304 publications were included. Size of hematoma was not significantly different (antithrombotic medication: OR 0.11, 95% CI (−0.67 to 0.89), p=0.78, ‘non-guideline adherent’ for puncture/removal: OR 0.13, 95% CI (−0.92 to 1.18), p=0.81). Patients receiving antithrombotic medication were more likely to have persistent neurological deficit (OR 2.00, 95% CI 1.24 to 3.23), p<0.01). Significance persisted after propensity score matching (p=0.04). Patients with non-guideline adherence had a 3.42 higher chance of persistent neurological deficit (95% CI 1.71 to 6.86, p<0.001). Discussion Antithrombotic medication is not significantly associated with hematoma size; however, the use of antithrombotic medication doubled the risk for persistent neurological deficit after spinal epidural hematoma. 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":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138826260","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 : 2023-12-18DOI: 10.1136/rapm-2023-105024
Nergis Nina Suleiman, Markus M Luedi, Girish Joshi, Geertrui Dewinter, Christopher L Wu, Axel R Sauter
Background/importance Cleft palate surgery is associated with significant postoperative pain. Effective pain control can decrease stress and agitation in children undergoing cleft palate surgery and improve surgical outcomes. However, limited evidence often results in inadequate pain control after cleft palate surgery. Objectives The aim of this review was to evaluate the available evidence and to develop recommendations for optimal pain management after cleft palate surgery using procedure-specific postoperative pain management (PROSPECT) methodology. Evidence review MEDLINE, Embase, and Cochrane Databases were searched for randomized controlled trials and systematic reviews assessing pain in children undergoing cleft palate repair published in English language from July 2002, through August 2023. Findings Of 1048 identified studies, 19 randomized controlled trials and 4 systematic reviews met the inclusion criteria. Interventions that improved postoperative pain, and are recommended, include suprazygomatic maxillary nerve block or palatal nerve block (if maxillary nerve block cannot be performed). Addition of dexmedetomidine to local anesthetic for suprazygomatic maxillary nerve block or, alternatively, as intravenous administration perioperatively is recommended. These interventions should be combined with a basic analgesic regimen including acetaminophen and nonsteroidal anti-inflammatory drugs. Of note, pre-incisional local anesthetic infiltration and dexamethasone were administered as a routine in several studies, however, because of limited procedure-specific evidence their contribution to pain relief after cleft palate surgery remains unknown. Conclusion The present review identified an evidence-based analgesic regimen for cleft palate surgery in pediatric patients. PROSPERO registration number CRD42022364788.
{"title":"Perioperative pain management for cleft palate surgery: a systematic review and procedure-specific postoperative pain management (PROSPECT) recommendations","authors":"Nergis Nina Suleiman, Markus M Luedi, Girish Joshi, Geertrui Dewinter, Christopher L Wu, Axel R Sauter","doi":"10.1136/rapm-2023-105024","DOIUrl":"https://doi.org/10.1136/rapm-2023-105024","url":null,"abstract":"Background/importance Cleft palate surgery is associated with significant postoperative pain. Effective pain control can decrease stress and agitation in children undergoing cleft palate surgery and improve surgical outcomes. However, limited evidence often results in inadequate pain control after cleft palate surgery. Objectives The aim of this review was to evaluate the available evidence and to develop recommendations for optimal pain management after cleft palate surgery using procedure-specific postoperative pain management (PROSPECT) methodology. Evidence review MEDLINE, Embase, and Cochrane Databases were searched for randomized controlled trials and systematic reviews assessing pain in children undergoing cleft palate repair published in English language from July 2002, through August 2023. Findings Of 1048 identified studies, 19 randomized controlled trials and 4 systematic reviews met the inclusion criteria. Interventions that improved postoperative pain, and are recommended, include suprazygomatic maxillary nerve block or palatal nerve block (if maxillary nerve block cannot be performed). Addition of dexmedetomidine to local anesthetic for suprazygomatic maxillary nerve block or, alternatively, as intravenous administration perioperatively is recommended. These interventions should be combined with a basic analgesic regimen including acetaminophen and nonsteroidal anti-inflammatory drugs. Of note, pre-incisional local anesthetic infiltration and dexamethasone were administered as a routine in several studies, however, because of limited procedure-specific evidence their contribution to pain relief after cleft palate surgery remains unknown. Conclusion The present review identified an evidence-based analgesic regimen for cleft palate surgery in pediatric patients. PROSPERO registration number CRD42022364788.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138743691","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 : 2023-12-16DOI: 10.1136/rapm-2023-105151
De Q Tran, Karin Booysen, Hendrik J Botha
Primary failure of thoracic epidural analgesia (TEA) remains an important clinical problem, whose incidence can exceed 20% in teaching centers. Since loss-of-resistance (LOR) constitutes the most popular method to identify the thoracic epidural space, the etiology of primary TEA failure can often be attributed to LOR’s low specificity. Interspinous ligamentous cysts, non-fused ligamenta flava, paravertebral muscles, intermuscular planes, and thoracic paravertebral spaces can all result in non-epidural LORs. Fluoroscopy, epidural waveform analysis, electrical stimulation, and ultrasonography have been proposed as confirmatory modalities for LOR. The current evidence derived from randomized trials suggests that fluoroscopy, epidural waveform analysis, and possibly electrical stimulation, could decrease the primary TEA failure to 2%. In contrast, preprocedural ultrasound scanning provides no incremental benefit when compared with conventional LOR. In the hands of experienced operators, real-time ultrasound guidance of the epidural needle has been demonstrated to provide comparable efficacy and efficiency to fluoroscopy. Further research is required to determine the most cost-effective confirmatory modality as well as the best adjuncts for novice operators and for patients with challenging anatomy. Moreover, future trials should elucidate if fluoroscopy and electrical stimulation could potentially decrease the secondary failure rate of TEA, and if a combination of confirmatory modalities could outperform individual ones.
原发性胸硬膜外镇痛（TEA）失败仍是一个重要的临床问题，在教学中心的发生率可能超过 20%。由于失阻（LOR）是确定胸硬膜外腔的最常用方法，因此原发性 TEA 失败的病因通常可归咎于 LOR 的低特异性。棘间韧带囊肿、未融合的韧带瓣、椎旁肌肉、肌间平面和胸椎旁间隙都可能导致非硬膜外 LOR。有人建议将透视、硬膜外波形分析、电刺激和超声波检查作为 LOR 的确诊方法。目前来自随机试验的证据表明，透视、硬膜外波形分析以及可能的电刺激可将原发性 TEA 失败率降至 2%。相比之下，与传统 LOR 相比，术前超声扫描并不能带来更多益处。在经验丰富的操作者手中，硬膜外针的实时超声引导已被证明具有与透视检查相当的疗效和效率。需要进一步研究确定最具成本效益的确认方式，以及新手操作者和具有挑战性解剖结构的患者的最佳辅助工具。此外，未来的试验应阐明透视和电刺激是否有可能降低 TEA 的二次失败率，以及多种确认方式的组合是否优于单个方式。
{"title":"Primary failure of thoracic epidural analgesia: revisited","authors":"De Q Tran, Karin Booysen, Hendrik J Botha","doi":"10.1136/rapm-2023-105151","DOIUrl":"https://doi.org/10.1136/rapm-2023-105151","url":null,"abstract":"Primary failure of thoracic epidural analgesia (TEA) remains an important clinical problem, whose incidence can exceed 20% in teaching centers. Since loss-of-resistance (LOR) constitutes the most popular method to identify the thoracic epidural space, the etiology of primary TEA failure can often be attributed to LOR’s low specificity. Interspinous ligamentous cysts, non-fused ligamenta flava, paravertebral muscles, intermuscular planes, and thoracic paravertebral spaces can all result in non-epidural LORs. Fluoroscopy, epidural waveform analysis, electrical stimulation, and ultrasonography have been proposed as confirmatory modalities for LOR. The current evidence derived from randomized trials suggests that fluoroscopy, epidural waveform analysis, and possibly electrical stimulation, could decrease the primary TEA failure to 2%. In contrast, preprocedural ultrasound scanning provides no incremental benefit when compared with conventional LOR. In the hands of experienced operators, real-time ultrasound guidance of the epidural needle has been demonstrated to provide comparable efficacy and efficiency to fluoroscopy. Further research is required to determine the most cost-effective confirmatory modality as well as the best adjuncts for novice operators and for patients with challenging anatomy. Moreover, future trials should elucidate if fluoroscopy and electrical stimulation could potentially decrease the secondary failure rate of TEA, and if a combination of confirmatory modalities could outperform individual ones.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138682409","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 : 2023-12-16DOI: 10.1136/rapm-2023-104992
Caroline S Zubieta, Christina Shabet, James Lin, Aurelio Muzaurieta, Akul Arora, Nazanin Maghsoodi, Chad M Brummett, Anthony Edelman
Approximately 1 in 10 patients undergoing surgery is considered at high risk for poor pain and opioid-related outcomes due to chronic pain or persistent opioid use prior to surgery, leading to increased hospital lengths of stay, emergency department visits, hospital readmissions, and worse long-term outcomes. Multidisciplinary transitional pain services (TPSs) have been shown to effectively identify and optimize high-risk patients before surgery, leading to a reduction in healthcare utilization. We conducted a series of semistructured interviews, a literature search, and a financial analysis to develop a reproducible business case for establishing a TPS. These interviews involved discussions with clinicians and administrators at Michigan Medicine, as well as leaders of TPS initiatives at peer institutions across the USA and Canada. The aim was to understand possible operational structures and potential sources of revenue and cost savings that needed inclusion in our model. Subsequently, the authors developed a modifiable financial modeling tool, which is freely available for download and adaptable to any healthcare institution. The model suggests that the primary source of cost savings can be attributed to a reduction in length of stay. Furthermore, several operational options exist for incorporating a TPS that performs at breakeven or positive net profit. This tool and these findings are important for informing health systems of operational and financial considerations when implementing a TPS program. Future research should evaluate this financial tool’s reproducibility in community health system contexts. All data relevant to the study are included in the article or uploaded as supplementary information.
{"title":"Financial model for a transitional pain service at a large tertiary academic center in the USA","authors":"Caroline S Zubieta, Christina Shabet, James Lin, Aurelio Muzaurieta, Akul Arora, Nazanin Maghsoodi, Chad M Brummett, Anthony Edelman","doi":"10.1136/rapm-2023-104992","DOIUrl":"https://doi.org/10.1136/rapm-2023-104992","url":null,"abstract":"Approximately 1 in 10 patients undergoing surgery is considered at high risk for poor pain and opioid-related outcomes due to chronic pain or persistent opioid use prior to surgery, leading to increased hospital lengths of stay, emergency department visits, hospital readmissions, and worse long-term outcomes. Multidisciplinary transitional pain services (TPSs) have been shown to effectively identify and optimize high-risk patients before surgery, leading to a reduction in healthcare utilization. We conducted a series of semistructured interviews, a literature search, and a financial analysis to develop a reproducible business case for establishing a TPS. These interviews involved discussions with clinicians and administrators at Michigan Medicine, as well as leaders of TPS initiatives at peer institutions across the USA and Canada. The aim was to understand possible operational structures and potential sources of revenue and cost savings that needed inclusion in our model. Subsequently, the authors developed a modifiable financial modeling tool, which is freely available for download and adaptable to any healthcare institution. The model suggests that the primary source of cost savings can be attributed to a reduction in length of stay. Furthermore, several operational options exist for incorporating a TPS that performs at breakeven or positive net profit. This tool and these findings are important for informing health systems of operational and financial considerations when implementing a TPS program. Future research should evaluate this financial tool’s reproducibility in community health system contexts. All data relevant to the study are included in the article or uploaded as supplementary information.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138682494","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 : 2023-12-11DOI: 10.1136/rapm-2023-105090
Matthew C Mauck, Samuel A McLean
On behalf of the authors, we thank Lee, Butt and Pak for their interest in our work and recent letter to the editor.[1 2][1] Lee et al point out an important weakness of our study that warrants further exploration in future research. We broadly categorized motor vehicle collisions by International
我们代表作者感谢 Lee、Butt 和 Pak 对我们工作的关注以及最近写给编辑的信。[1 2][1] Lee 等人指出了我们研究的一个重要缺陷，值得在今后的研究中进一步探讨。我们将机动车碰撞大致分为以下几类
{"title":"Response to comments on: incidence of persistent opioid use following traumatic injury","authors":"Matthew C Mauck, Samuel A McLean","doi":"10.1136/rapm-2023-105090","DOIUrl":"https://doi.org/10.1136/rapm-2023-105090","url":null,"abstract":"On behalf of the authors, we thank Lee, Butt and Pak for their interest in our work and recent letter to the editor.[1 2][1] Lee et al point out an important weakness of our study that warrants further exploration in future research. We broadly categorized motor vehicle collisions by International","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138573232","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 : 2022-09-21DOI: 10.1136/rapm-2022-ASRA_ABSTRACTS
K. Norton, S. Atoa, Eric M. Tretter, J. Macdonald, Anne Castro, P. Narciso, Abuzar B. Baloach, E. Buckley, J. Chelly
{"title":"Scientific Abstracts from the 47th Annual Regional Anesthesiology and Acute Pain Medicine Meeting, March 31–April 2, 2022, Las Vegas, Nevada","authors":"K. Norton, S. Atoa, Eric M. Tretter, J. Macdonald, Anne Castro, P. Narciso, Abuzar B. Baloach, E. Buckley, J. Chelly","doi":"10.1136/rapm-2022-ASRA_ABSTRACTS","DOIUrl":"https://doi.org/10.1136/rapm-2022-ASRA_ABSTRACTS","url":null,"abstract":"","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73622515","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 : 2022-09-09DOI: 10.1136/rapm-2022-104009
Chenghui Cai, Rong Shi, Yun Wang
To the editor We read with intense interest the recently published article by Lee et al in regard to the comparison of postoperative analgesic effects between posterior quadratus lumborum block (QLB) and intrathecal morphine (ITM) in laparoscopic donor hepatectomy. We highly appreciate the efforts of the authors in conducting this outstanding study. Nevertheless, we feel that there may be some uncertainties in this study. In this study, intravenous patientcontrolled analgesia with fentanyl was programmed to deliver a 15 μg bolus (1 mL) dose and a lockout interval of 15 min in the postanesthetic care unit (PACU). When Numeric Rating Scale (NRS) >4, some additional pain remedies would be implemented, as intravenous pethidine (25 mg) was injected as firstline therapy. Intravenous fentanyl (25–50 μg) would injected when the target analgesic effect was not achieved after 15 min. And at surgical wards, all participants received intravenous ibuprofen or oral Mypol capsule for pain management. When NRS>4, intravenous hydromorphone (2 mg) was injected. The primary outcome in the study was the resting pain score at 24 hours postsurgery. The results showed that, in both groups, the median pain score at admission to PACU was beyond 6, with a maximum of 10. And a lot of patients in both QLB and ITM group still had pain scores greater than 4 at 24 and 48 hours postsurgery. It indicated that there were many patients who failed to achieve analgesic goal after surgery, making us doubt whether the general analgesic program in this paper is appropriate. What’s more, the mean differences of resting pain score at 24 hours postsurgery between QLB and ITM groups was 1.11, which is lower than the recommended minimal clinically important difference 1.5. It indicated that the difference in resting pain score is of no clinical value and meets the definition of noninferiority. We think that the predetermined noninferiority margin (δ) was too small to acquire the noninferiority result. We would be interested in hearing the author’s thoughts on our concerns.
{"title":"Problem with non-inferiority margin: a letter to the editor","authors":"Chenghui Cai, Rong Shi, Yun Wang","doi":"10.1136/rapm-2022-104009","DOIUrl":"https://doi.org/10.1136/rapm-2022-104009","url":null,"abstract":"To the editor We read with intense interest the recently published article by Lee et al in regard to the comparison of postoperative analgesic effects between posterior quadratus lumborum block (QLB) and intrathecal morphine (ITM) in laparoscopic donor hepatectomy. We highly appreciate the efforts of the authors in conducting this outstanding study. Nevertheless, we feel that there may be some uncertainties in this study. In this study, intravenous patientcontrolled analgesia with fentanyl was programmed to deliver a 15 μg bolus (1 mL) dose and a lockout interval of 15 min in the postanesthetic care unit (PACU). When Numeric Rating Scale (NRS) >4, some additional pain remedies would be implemented, as intravenous pethidine (25 mg) was injected as firstline therapy. Intravenous fentanyl (25–50 μg) would injected when the target analgesic effect was not achieved after 15 min. And at surgical wards, all participants received intravenous ibuprofen or oral Mypol capsule for pain management. When NRS>4, intravenous hydromorphone (2 mg) was injected. The primary outcome in the study was the resting pain score at 24 hours postsurgery. The results showed that, in both groups, the median pain score at admission to PACU was beyond 6, with a maximum of 10. And a lot of patients in both QLB and ITM group still had pain scores greater than 4 at 24 and 48 hours postsurgery. It indicated that there were many patients who failed to achieve analgesic goal after surgery, making us doubt whether the general analgesic program in this paper is appropriate. What’s more, the mean differences of resting pain score at 24 hours postsurgery between QLB and ITM groups was 1.11, which is lower than the recommended minimal clinically important difference 1.5. It indicated that the difference in resting pain score is of no clinical value and meets the definition of noninferiority. We think that the predetermined noninferiority margin (δ) was too small to acquire the noninferiority result. We would be interested in hearing the author’s thoughts on our concerns.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83268805","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 : 2022-09-09DOI: 10.1136/rapm-2022-104036
R. Kang, Seungwon Lee, J. Ko
We thank Cai et al for their comments on our study. We performed our study to evaluate the analgesic efficacy of quadratus lumborum block (QLB) or intrathecal morphine (ITM) as part of a multimodal analgesic regimen. In our institution, postoperative pain management in the surgical ward is usually conducted by the surgical team, and we agree that postoperative pain management needs to be refined, and thus, we regularly discuss with the surgical team to improve patient recovery. Most patients in both groups had moderate to high abdominal pain or discomfort at the time of postoperative care unit (PACU) admission, as shown in figure 3 of our study, which was also consistent with our previous studies. The high pain level may reflect significant visceral pain combined with somatic pain. In addition, some patients in both groups had moderate pain at 24 hours and 48 hours after surgery because the analgesic duration might have worn off at 12 hours after QLB and at 36 hours after ITM, respectively. Second, we agree that the predetermined noninferiority margin of 1 might be small, which was already mentioned in the limitation. In our study, the predetermined noninferiority margin was set based on our previous study and review article for noninferiority analysis. Since the mean resting pain score at 24 hours is relatively low in the ITM group, we hypothesised that the noninferiority margin should also have to be low to compare QLB as an alternative to ITM. However, we disagree that the median minimal clinically significant differences for pain scores should be 1.5 at rest, since this value is usually applicable for total hip or knee arthroplasty, and not for liver surgery, especially in living donors. This should be elucidated in future studies. I appreciate your interest in our research.
{"title":"Comparison of postoperative analgesic effects of posterior quadratus lumborum block and intrathecal morphine in laparoscopic donor hepatectomy: in reply","authors":"R. Kang, Seungwon Lee, J. Ko","doi":"10.1136/rapm-2022-104036","DOIUrl":"https://doi.org/10.1136/rapm-2022-104036","url":null,"abstract":"We thank Cai et al for their comments on our study. We performed our study to evaluate the analgesic efficacy of quadratus lumborum block (QLB) or intrathecal morphine (ITM) as part of a multimodal analgesic regimen. In our institution, postoperative pain management in the surgical ward is usually conducted by the surgical team, and we agree that postoperative pain management needs to be refined, and thus, we regularly discuss with the surgical team to improve patient recovery. Most patients in both groups had moderate to high abdominal pain or discomfort at the time of postoperative care unit (PACU) admission, as shown in figure 3 of our study, which was also consistent with our previous studies. The high pain level may reflect significant visceral pain combined with somatic pain. In addition, some patients in both groups had moderate pain at 24 hours and 48 hours after surgery because the analgesic duration might have worn off at 12 hours after QLB and at 36 hours after ITM, respectively. Second, we agree that the predetermined noninferiority margin of 1 might be small, which was already mentioned in the limitation. In our study, the predetermined noninferiority margin was set based on our previous study and review article for noninferiority analysis. Since the mean resting pain score at 24 hours is relatively low in the ITM group, we hypothesised that the noninferiority margin should also have to be low to compare QLB as an alternative to ITM. However, we disagree that the median minimal clinically significant differences for pain scores should be 1.5 at rest, since this value is usually applicable for total hip or knee arthroplasty, and not for liver surgery, especially in living donors. This should be elucidated in future studies. I appreciate your interest in our research.","PeriodicalId":21046,"journal":{"name":"Regional Anesthesia & Pain Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85099534","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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