Regional Anesthesia and Pain Medicine最新文献

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.

Introduction: There are currently no published studies using patient reviews of pain physicians to quantitatively assess patient preferences for pain physician attributes. The aim of the present study was to use natural language processing to quantitatively analyze patient reviews of pain physicians by determining the effect of physician demographics and word frequency on positive review outcomes.

Methods: Using a peer-reviewed algorithm, online Healthgrades reviews of pain physicians practicing in the USA were scored according to their positive sentiment from -1 to 1. These sentiment scores and star ratings were used to compare physicians by age, gender and region of practice. Frequency analysis of words and bigrams was performed for all reviews.

Results: There were 15 101 reviews collected among 1275 pain physicians which showed male physicians received higher star ratings and review sentiment scores than female physicians. Pain physicians younger than 55 years received higher star ratings and sentiment scores than those of 55 years and older. Frequency analysis revealed that words most commonly used in the more positive patient reviews included 'care', 'professional', 'patient', 'help' and 'kind'; the words most commonly used in less positive reviews included 'pain', 'back', 'office', 'time' and 'years'.

Conclusions: Male and/or younger pain physicians receive more positive reviews. Patients highly rate pain physicians who are perceived as personable. Patients lowly rate physicians who are perceived as providing ineffective treatment of their pain as well as when they experience barriers to their access to care.

Introduction: It has been well described that a small but significant proportion of patients continue to use opioids months after surgical discharge. We sought to evaluate postdischarge opioid use of patients who were seen by a Transitional Pain Service compared with controls.

Methods: We conducted a retrospective cohort study using administrative data of individuals who underwent surgery in Ontario, Canada from 2014 to 2018. Matched cohort pairs were created by matching Transitional Pain Service patients to patients of other academic hospitals in Ontario who were not enrolled in a Transitional Pain Service. Segmented regression was performed to assess changes in monthly mean daily opioid dosage.

Results: A total of 209 Transitional Pain Service patients were matched to 209 patients who underwent surgery at other academic centers. Over the 12 months after surgery, the mean daily dose decreased by an estimated 3.53 morphine milligram equivalents (95% CI 2.67 to 4.39, p<0.001) per month for the Transitional Pain Service group, compared with a decline of only 1.05 morphine milligram equivalents (95% CI 0.43 to 1.66, p<0.001) for the controls. The difference-in-difference change in opioid use for the Transitional Pain Service group versus the control group was -2.48 morphine milligram equivalents per month (95% CI -3.54 to -1.43, p=0.003).

Discussion: Patients enrolled in the Transitional Pain Service were able to achieve opioid dose reduction faster than in the control cohorts. The difficulty in finding an appropriate control group for this retrospective study highlights the need for future randomized controlled trials to determine efficacy.

Excessive alcohol consumption and alcohol use disorder (AUD) increase the risk of perioperative morbidity and mortality. Aspiration, malnutrition, coagulopathies, seizures, and hemodynamic alterations are only a few of the major concerns related to acute alcohol intoxication and AUD. There are also numerous physiological effects, changes in medication metabolism and pharmacology, and adverse events related to chronic alcohol consumption. These are all important considerations for the anesthesiologist in the perioperative management of a patient with AUD. Pain perception and thresholds are altered in patients with acute and chronic alcohol use. Medications used to manage AUD symptoms, particularly naltrexone, can have significant perioperative implications. Patients on naltrexone who continue or stop this medication in the perioperative period are at an increased risk for undertreated pain or substance use relapse. This review highlights key considerations for the anesthesiologist and pain physician in the perioperative management of patients with active AUD (or those in recovery). It discusses the effects of acute and chronic alcohol use on pain perception and thresholds, provides guidance on the perioperative management of naltrexone and low-dose naltrexone, and reviews a multimodal approach to pain management.

Objective: This study aimed to optimize the formulation of magnetically targeted lidocaine microspheres, reduce the microsphere particle size, and increase the drug loading and encapsulation rate of lidocaine. The optimized microspheres were characterized, and their pharmacokinetics and effective radii of action were studied.

Methods: The preparation of magnetically targeted lidocaine microspheres was optimized using ultrasonic emulsification-solvent evaporation. The Box-Behnken design method and response surface method were used for optimization. The optimized microspheres were characterized and tested for their in vitro release. Blood concentrations were analyzed using a non-compartment model, and the main pharmacokinetic parameters (half-life (t_1/2 ), maximum blood concentration, area under the blood concentration-time curve (AUC), time to peak (T_max ), and mean retention time (MRT) were calculated. Pathological sections were stained to study the safety of the microsphere tissues. A rabbit sciatic nerve model was used to determine the "standard time (t₀ )" and effective radius of the microspheres.

Results: The optimized lidocaine microspheres exhibited significantly reduced particle size and increased drug loading and encapsulation rates. Pharmacokinetic experiments showed that the t_1/2 , T_max , and MRT of magnetically targeted lidocaine microspheres were significantly prolonged in the magnetic field, and the AUC_0-48 and AUC_0-∞ were significantly decreased. Its pharmacodynamic radius was 31.47 mm.

Conclusion: Magnetically targeted lidocaine microspheres provide sustained long-lasting release, neurotargeting, nerve blocking, and high tissue safety. This preparation has a significantly low blood concentration and a slow release in vivo, which can reduce local anesthetic entry into the blood. This may be a novel and effective method for improving postoperative comfort and treating chronic pain. This provides a countermeasure for exploring the size of the magnetic field for the application of magnetic drug-carrying materials.