Pub Date : 2024-09-26DOI: 10.1136/rapm-2024-105721
Graeme A McLeod, Amy Sadler, Andre Boezaart, Xavier Sala-Blanch, Miguel Angel Reina
Postmortem histology and in vivo, animal-based ultra-high-definition microultrasound demonstrate a complex array of non-communicating adipose tissue compartments enclosed by fascia. Classic nerve block mechanisms and histology do not consider this tissue. Injected local anesthetic agents can occupy any of these adipose compartments, which may explain the significant differences in outcomes such as success rates, onset time, block density, duration of nerve block, and secondary continuous block failure. Furthermore, these adipose tissue compartments may influence injection pressures, making conclusions about needle tip location unreliable. This educational review will explain the neural anatomy associated with these fatty compartments in detail and suggest how they may affect block outcomes.
{"title":"Peripheral nerve microanatomy: new insights into possible mechanisms for block success.","authors":"Graeme A McLeod, Amy Sadler, Andre Boezaart, Xavier Sala-Blanch, Miguel Angel Reina","doi":"10.1136/rapm-2024-105721","DOIUrl":"https://doi.org/10.1136/rapm-2024-105721","url":null,"abstract":"<p><p>Postmortem histology and in vivo, animal-based ultra-high-definition microultrasound demonstrate a complex array of non-communicating adipose tissue compartments enclosed by fascia. Classic nerve block mechanisms and histology do not consider this tissue. Injected local anesthetic agents can occupy any of these adipose compartments, which may explain the significant differences in outcomes such as success rates, onset time, block density, duration of nerve block, and secondary continuous block failure. Furthermore, these adipose tissue compartments may influence injection pressures, making conclusions about needle tip location unreliable. This educational review will explain the neural anatomy associated with these fatty compartments in detail and suggest how they may affect block outcomes.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-26DOI: 10.1136/rapm-2024-105701
Miriam Sheetz, Angela Puglisi, Mark Trentalange, Julia Reichel, Brian Chalmers, Alejandro Gonzalez Della Valle, Alexandra Sideris, Bradley H Lee
Background: Patients undergoing total knee arthroplasty (TKA) experience significant postoperative pain and routinely require opioids, yet they often lack knowledge regarding appropriate use and handling of these medications. Evidence suggests that educational interventions in various formats may help reinforce proper usage and improve postoperative pain control. The aim of this study is to compare the institution standard of care (webinar) with two novel educational interventions-one in-person and the other a video recording-that focus specifically on the use of opioids and pain control.
Methods: This prospective, randomized pilot study included 42 patients undergoing TKA. Patients were randomized into one of three groups: (1) webinar: 50 min virtual session standard of care at Hospital for Special Surgery (HSS), (2) in-person education, or (3) video education. The primary outcomes of this study were the number of opioid refill requests through postoperative day (POD) 30 and POD 60. The secondary outcomes evaluated Numerical Rating Scale (NRS) pain scores, opioid consumption in oral morphine equivalents (OME), surveys on medication usage and opioid knowledge, reported medication storage and disposal. We hypothesize that the novel educational interventions, presented either in-person or by video, will lead to a decrease in opioid refills within 60 days compared with current education delivered through virtual webinar.
Results: No significant differences were found among groups in the number of opioid refill requests, average NRS pain score, or OME consumption at any time point. Opioid refill requests ranged from 0% to 16.7% at POD 30 (Fisher's exact test, p=0.625) and from 0% to 8.3% at POD 60 (p=1.000). The median opioid refill request was zero requests per group from POD 21 to 60 (webinar 0 (0.0, 0.0), in-person 0 (0.0, 0.0), video 0 (0.0, 0.0), Kruskal-Wallis test, p=0.381). Average NRS pain scores were 5 or below for all groups on POD 1, 7 and 14. By POD 7, all groups had an average daily intake OME of 14 or below.
Conclusions: Overall, patients in each group did well with postoperative pain management after TKA and had minimal opioid refill requests. There were no statistically significant differences in outcomes of NRS pain scores or opioid usage among groups suggesting that educational interventions were similarly effective. As a pilot trial, study demonstrated successful recruitment and retention of participants, and important feedback was elicited from patients regarding education, as well. Of note, this was a pilot study and was likely underpowered to detect a difference.
{"title":"Comparing modalities of opioid education in patients undergoing total knee arthroplasty: a randomized pilot trial.","authors":"Miriam Sheetz, Angela Puglisi, Mark Trentalange, Julia Reichel, Brian Chalmers, Alejandro Gonzalez Della Valle, Alexandra Sideris, Bradley H Lee","doi":"10.1136/rapm-2024-105701","DOIUrl":"https://doi.org/10.1136/rapm-2024-105701","url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing total knee arthroplasty (TKA) experience significant postoperative pain and routinely require opioids, yet they often lack knowledge regarding appropriate use and handling of these medications. Evidence suggests that educational interventions in various formats may help reinforce proper usage and improve postoperative pain control. The aim of this study is to compare the institution standard of care (webinar) with two novel educational interventions-one in-person and the other a video recording-that focus specifically on the use of opioids and pain control.</p><p><strong>Methods: </strong>This prospective, randomized pilot study included 42 patients undergoing TKA. Patients were randomized into one of three groups: (1) webinar: 50 min virtual session standard of care at Hospital for Special Surgery (HSS), (2) in-person education, or (3) video education. The primary outcomes of this study were the number of opioid refill requests through postoperative day (POD) 30 and POD 60. The secondary outcomes evaluated Numerical Rating Scale (NRS) pain scores, opioid consumption in oral morphine equivalents (OME), surveys on medication usage and opioid knowledge, reported medication storage and disposal. We hypothesize that the novel educational interventions, presented either in-person or by video, will lead to a decrease in opioid refills within 60 days compared with current education delivered through virtual webinar.</p><p><strong>Results: </strong>No significant differences were found among groups in the number of opioid refill requests, average NRS pain score, or OME consumption at any time point. Opioid refill requests ranged from 0% to 16.7% at POD 30 (Fisher's exact test, p=0.625) and from 0% to 8.3% at POD 60 (p=1.000). The median opioid refill request was zero requests per group from POD 21 to 60 (webinar 0 (0.0, 0.0), in-person 0 (0.0, 0.0), video 0 (0.0, 0.0), Kruskal-Wallis test, p=0.381). Average NRS pain scores were 5 or below for all groups on POD 1, 7 and 14. By POD 7, all groups had an average daily intake OME of 14 or below.</p><p><strong>Conclusions: </strong>Overall, patients in each group did well with postoperative pain management after TKA and had minimal opioid refill requests. There were no statistically significant differences in outcomes of NRS pain scores or opioid usage among groups suggesting that educational interventions were similarly effective. As a pilot trial, study demonstrated successful recruitment and retention of participants, and important feedback was elicited from patients regarding education, as well. Of note, this was a pilot study and was likely underpowered to detect a difference.</p><p><strong>Trial registration number: </strong>NCT05593341.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-24DOI: 10.1136/rapm-2024-105791
Michelle Lim, Christina L Jeng, Garrett W Burnett, Chang H Park
Background and objectives: Most Regional Anesthesiology and Acute Pain Medicine (RAAPM) fellowship programs transitioned to virtual interviews in 2020 because of the COVID-19 pandemic. Then, the RAAPM fellowship match started in 2023 in order to make the application process more equitable. In this study, we surveyed RAAPM fellowship program directors (PDs) to determine how such major events of the early 2020s shaped the fellowship application process.
Methods: A 16-question survey was distributed to US RAAPM program directors. The survey aimed to assess whether PDs prefer the fellowship match over the previous rolling application format and to gauge PDs' confidence in using virtual interviews to evaluate applicants.
Results: 56 (71%) RAAPM program directors completed the survey. 79% of respondents participated in the inaugural match. 59% of PDs preferred the fellowship match over the rolling application format. The interview was rated the most important selection criterion. Of the 93% of PDs who switched to virtual interviews during the pandemic, only 4 PDs (7%) resumed in-person interviews in some capacity. Majority of PDs believed that virtual interviews were not inferior to in-person interviews for assessing applicants; 48% of respondents preferred virtual interviews over in-person interviews.
Conclusions: Most RAAPM programs continued to conduct virtual interviews exclusively. Majority of program directors preferred the fellowship match. PDs ranked the interview as the most important selection factor. Most PDs thought virtual interviews were not inferior to in-person interviews, but they remained divided on which format they prefer.
{"title":"Evolving Regional Anesthesiology and Acute Pain Medicine fellowship application process: a program director survey.","authors":"Michelle Lim, Christina L Jeng, Garrett W Burnett, Chang H Park","doi":"10.1136/rapm-2024-105791","DOIUrl":"https://doi.org/10.1136/rapm-2024-105791","url":null,"abstract":"<p><strong>Background and objectives: </strong>Most Regional Anesthesiology and Acute Pain Medicine (RAAPM) fellowship programs transitioned to virtual interviews in 2020 because of the COVID-19 pandemic. Then, the RAAPM fellowship match started in 2023 in order to make the application process more equitable. In this study, we surveyed RAAPM fellowship program directors (PDs) to determine how such major events of the early 2020s shaped the fellowship application process.</p><p><strong>Methods: </strong>A 16-question survey was distributed to US RAAPM program directors. The survey aimed to assess whether PDs prefer the fellowship match over the previous rolling application format and to gauge PDs' confidence in using virtual interviews to evaluate applicants.</p><p><strong>Results: </strong>56 (71%) RAAPM program directors completed the survey. 79% of respondents participated in the inaugural match. 59% of PDs preferred the fellowship match over the rolling application format. The interview was rated the most important selection criterion. Of the 93% of PDs who switched to virtual interviews during the pandemic, only 4 PDs (7%) resumed in-person interviews in some capacity. Majority of PDs believed that virtual interviews were not inferior to in-person interviews for assessing applicants; 48% of respondents preferred virtual interviews over in-person interviews.</p><p><strong>Conclusions: </strong>Most RAAPM programs continued to conduct virtual interviews exclusively. Majority of program directors preferred the fellowship match. PDs ranked the interview as the most important selection factor. Most PDs thought virtual interviews were not inferior to in-person interviews, but they remained divided on which format they prefer.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-24DOI: 10.1136/rapm-2024-106019
Axel Semmelmann
{"title":"Reply to the letter by Yang.","authors":"Axel Semmelmann","doi":"10.1136/rapm-2024-106019","DOIUrl":"https://doi.org/10.1136/rapm-2024-106019","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-24DOI: 10.1136/rapm-2024-105983
Guanyu Yang
{"title":"Mortality in patients undergoing thoracotomy with continuous neuraxial analgesia.","authors":"Guanyu Yang","doi":"10.1136/rapm-2024-105983","DOIUrl":"https://doi.org/10.1136/rapm-2024-105983","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To investigate long-term explantation risks and causes for the explantation of neuromodulation devices for the treatment of chronic pain from different manufacturers.
Methods: This retrospective analysis included patients implanted with a system for spinal cord stimulation (SCS) or dorsal root ganglion (DRG) stimulation at Sahlgrenska University Hospital between January 2012 and December 2022. Patient characteristics, explantation rates and causes for explantation were obtained by reviewing medical records.
Results: In total, 400 patients were included in the study. Including all manufacturers, the cumulative explantation risk for any reason was 17%, 23% and 38% at 3, 5 and 10 years, respectively. Explantation risk due to diminished pain relief at the same intervals was 10%, 14% and 23%. A subgroup comparison of 5-year explantation risk using Kaplan-Meier analysis did not show a statistically significant difference between the manufacturers. In multivariable Cox regression analyses, there was no difference in explantation risk for any reason, but for explantation due to diminished pain relief, a higher risk was noted for Medtronic (preferably older types of SCS devices) and DRG stimulation. No other predictive factor for explantation was found.
Conclusions: Although SCS and DRG stimulation are well-established and safe treatments for chronic pain, the long-term explantation risk remains high. The difference between manufacturers highlights the importance of technological evolution for improving therapy outcomes. Increased stringency in patient selection and follow-up strategies, as well as further development of device hardware and software technology for increased longevity, could possibly reduce long-term explantation risks.
{"title":"Long-term explantation risk in patients with chronic pain treated with spinal cord or dorsal root ganglion stimulation.","authors":"Kliment Gatzinsky, Beatrice Brink, Kristin Lilja Eyglóardóttir, Tobias Hallén","doi":"10.1136/rapm-2024-105719","DOIUrl":"10.1136/rapm-2024-105719","url":null,"abstract":"<p><strong>Objective: </strong>To investigate long-term explantation risks and causes for the explantation of neuromodulation devices for the treatment of chronic pain from different manufacturers.</p><p><strong>Methods: </strong>This retrospective analysis included patients implanted with a system for spinal cord stimulation (SCS) or dorsal root ganglion (DRG) stimulation at Sahlgrenska University Hospital between January 2012 and December 2022. Patient characteristics, explantation rates and causes for explantation were obtained by reviewing medical records.</p><p><strong>Results: </strong>In total, 400 patients were included in the study. Including all manufacturers, the cumulative explantation risk for any reason was 17%, 23% and 38% at 3, 5 and 10 years, respectively. Explantation risk due to diminished pain relief at the same intervals was 10%, 14% and 23%. A subgroup comparison of 5-year explantation risk using Kaplan-Meier analysis did not show a statistically significant difference between the manufacturers. In multivariable Cox regression analyses, there was no difference in explantation risk for any reason, but for explantation due to diminished pain relief, a higher risk was noted for Medtronic (preferably older types of SCS devices) and DRG stimulation. No other predictive factor for explantation was found.</p><p><strong>Conclusions: </strong>Although SCS and DRG stimulation are well-established and safe treatments for chronic pain, the long-term explantation risk remains high. The difference between manufacturers highlights the importance of technological evolution for improving therapy outcomes. Increased stringency in patient selection and follow-up strategies, as well as further development of device hardware and software technology for increased longevity, could possibly reduce long-term explantation risks.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-06DOI: 10.1136/rapm-2024-105881
Alina Razak, Ehab Al Bizri, Youssef Fardos, Jamie Lee Romeiser, Elliott Bennett-Guerrero
{"title":"Nationwide survey of intraoperative methadone administration for perioperative analgesia.","authors":"Alina Razak, Ehab Al Bizri, Youssef Fardos, Jamie Lee Romeiser, Elliott Bennett-Guerrero","doi":"10.1136/rapm-2024-105881","DOIUrl":"https://doi.org/10.1136/rapm-2024-105881","url":null,"abstract":"","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-04DOI: 10.1136/rapm-2024-105454
Thomas Giral, Bernard Victor Delvaux, Davy Huynh, Bertrand Morel, Nabil Zanoun, Franck Ehooman, Thierry Garnier, Olivier Maupain
Background: During the postoperative period of elective cesarean section, intrathecal morphine is effective in the multimodal analgesic regimen, but can cause significant adverse effects. Bilateral posterior quadratus lumborum block could be alternatively used. The aim of this study was to compare efficacy and safety of both strategies as part of a multimodal analgesic regimen.
Methods: This was a prospective, randomized, blinded, controlled study. 104 parturients were randomly selected to receive intrathecal morphine or posterior quadratus lumborum block during cesarean section under spinal anesthesia. The primary endpoint was patient-controlled 24-hour cumulative intravenous morphine use. Secondary endpoints were 48-hour cumulative morphine use, static/dynamic pain scores, functional recovery (ObsQoR-11 questionnaire) and adverse effects.
Results: There was no statistical difference in the mean cumulative morphine dose at 24-hour between groups (posterior quadratus lumborum block group, 13.7 (97.5% CI 10.4 to 16.9) mg; intrathecal morphine group, 11.1 (97.5% CI 8.4 to 13.8) mg, p=0.111). Pain scores did not show any difference between groups, excepted at 6 hours for the pain at cough/movement in favor of the posterior quadratus lumborum block group (p=0.013). A better recovery quality was observed at 24 hours in the posterior quadratus lumborum block group (p=0.009). Pruritus was more frequent in intrathecal morphine group parturients (35% vs 2%) CONCLUSIONS: No difference in cumulative morphine dose at 24 hours was observed in posterior quadratus lumborum block group compared with intrathecal morphine group. Posterior quadratus lumborum block can be considered an alternative to intrathecal morphine in cesarean postoperative analgesia, especially in cases of intolerance to morphine.
Trial registration number: NCT04755712.
背景:在择期剖宫产术后,鞘内吗啡在多模式镇痛方案中是有效的,但会引起明显的不良反应。双侧腰后部阻滞可作为替代方法。本研究旨在比较这两种策略作为多模式镇痛方案一部分的有效性和安全性:这是一项前瞻性、随机、盲法对照研究。随机选取了104名产妇,让她们在脊髓麻醉下进行剖宫产手术时接受鞘内吗啡或腰后四肌阻滞。主要终点是由患者控制的 24 小时累积静脉注射吗啡用量。次要终点是48小时累积吗啡用量、静态/动态疼痛评分、功能恢复(ObsQoR-11问卷)和不良反应:各组 24 小时平均累积吗啡剂量无统计学差异(腰后区阻滞组,13.7(97.5% CI 10.4 至 16.9)毫克;鞘内吗啡组,11.1(97.5% CI 8.4 至 13.8)毫克,P=0.111)。疼痛评分在各组之间没有显示出任何差异,只有在6小时时,咳嗽/活动时的疼痛评分有利于后腰方肌阻滞组(P=0.013)。在 24 小时时,观察到腰后肌阻滞组的恢复质量更好(P=0.009)。鞘内吗啡组产妇瘙痒的发生率更高(35% 对 2% ):与鞘内吗啡组相比,腰后区阻滞组在 24 小时内的累积吗啡剂量没有差异。在剖宫产术后镇痛中,尤其是在对吗啡不耐受的情况下,腰后区阻滞可被视为鞘内吗啡的替代品:试验注册号:NCT04755712。
{"title":"Posterior quadratus lumborum block versus intrathecal morphine analgesia after scheduled cesarean section: a prospective, randomized, controlled study.","authors":"Thomas Giral, Bernard Victor Delvaux, Davy Huynh, Bertrand Morel, Nabil Zanoun, Franck Ehooman, Thierry Garnier, Olivier Maupain","doi":"10.1136/rapm-2024-105454","DOIUrl":"https://doi.org/10.1136/rapm-2024-105454","url":null,"abstract":"<p><strong>Background: </strong>During the postoperative period of elective cesarean section, intrathecal morphine is effective in the multimodal analgesic regimen, but can cause significant adverse effects. Bilateral posterior quadratus lumborum block could be alternatively used. The aim of this study was to compare efficacy and safety of both strategies as part of a multimodal analgesic regimen.</p><p><strong>Methods: </strong>This was a prospective, randomized, blinded, controlled study. 104 parturients were randomly selected to receive intrathecal morphine or posterior quadratus lumborum block during cesarean section under spinal anesthesia. The primary endpoint was patient-controlled 24-hour cumulative intravenous morphine use. Secondary endpoints were 48-hour cumulative morphine use, static/dynamic pain scores, functional recovery (ObsQoR-11 questionnaire) and adverse effects.</p><p><strong>Results: </strong>There was no statistical difference in the mean cumulative morphine dose at 24-hour between groups (posterior quadratus lumborum block group, 13.7 (97.5% CI 10.4 to 16.9) mg; intrathecal morphine group, 11.1 (97.5% CI 8.4 to 13.8) mg, p=0.111). Pain scores did not show any difference between groups, excepted at 6 hours for the pain at cough/movement in favor of the posterior quadratus lumborum block group (p=0.013). A better recovery quality was observed at 24 hours in the posterior quadratus lumborum block group (p=0.009). Pruritus was more frequent in intrathecal morphine group parturients (35% vs 2%) CONCLUSIONS: No difference in cumulative morphine dose at 24 hours was observed in posterior quadratus lumborum block group compared with intrathecal morphine group. Posterior quadratus lumborum block can be considered an alternative to intrathecal morphine in cesarean postoperative analgesia, especially in cases of intolerance to morphine.</p><p><strong>Trial registration number: </strong>NCT04755712.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-03DOI: 10.1136/rapm-2024-105770
Anuj Kailash Aggarwal, Meredith Barad, Nu Cindy Chai, Timothy Furnish, Puneet Mishra, Lynn Kohan, Susan Moeschler, Rajiv D Reddy, Bhavana Yalamuru
The National Resident Matching Program (NRMP) for pain medicine fellowships marked its 10th anniversary in 2023, coinciding with growing discussions within the Association of Pain Program Directors (APPD) regarding the program's future in the context of a recent decline of applicants into pain medicine. This letter explores the rationale behind reassessing the NRMP's utility for pain medicine, examining historical and current trends, and considering the implications of withdrawing from the match. Despite a recent decline in applicants and an increase in unfilled positions, the APPD advocates for continued participation in the match. The match ensures equitable and stable recruitment, preventing the chaotic pre-match environment of competitive, early offers. Data from similar specialties highlight the pitfalls of non-match systems, such as increased applicant pressure and reduced program visibility. The APPD supports maintaining the NRMP match while implementing reforms like preference signaling to address evolving challenges. The APPD aims to preserve the match's benefits and ensure a stable future for pain medicine fellowship recruitment.
{"title":"Current state of the pain medicine match: perspective and an eye to the future.","authors":"Anuj Kailash Aggarwal, Meredith Barad, Nu Cindy Chai, Timothy Furnish, Puneet Mishra, Lynn Kohan, Susan Moeschler, Rajiv D Reddy, Bhavana Yalamuru","doi":"10.1136/rapm-2024-105770","DOIUrl":"https://doi.org/10.1136/rapm-2024-105770","url":null,"abstract":"<p><p>The National Resident Matching Program (NRMP) for pain medicine fellowships marked its 10th anniversary in 2023, coinciding with growing discussions within the Association of Pain Program Directors (APPD) regarding the program's future in the context of a recent decline of applicants into pain medicine. This letter explores the rationale behind reassessing the NRMP's utility for pain medicine, examining historical and current trends, and considering the implications of withdrawing from the match. Despite a recent decline in applicants and an increase in unfilled positions, the APPD advocates for continued participation in the match. The match ensures equitable and stable recruitment, preventing the chaotic pre-match environment of competitive, early offers. Data from similar specialties highlight the pitfalls of non-match systems, such as increased applicant pressure and reduced program visibility. The APPD supports maintaining the NRMP match while implementing reforms like preference signaling to address evolving challenges. The APPD aims to preserve the match's benefits and ensure a stable future for pain medicine fellowship recruitment.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":null,"pages":null},"PeriodicalIF":5.1,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}