REGIONAL ANESTHESIA & PAIN MEDICINE 是美国区域麻醉和疼痛医学协会 (ASRA) 的官方出版物，是一份月刊，发表经过同行评审的科学和临床研究，以促进对手术麻醉和区域技术的理解和临床应用术后镇痛。覆盖范围包括术中区域技术、围手术期疼痛、慢性疼痛、产科麻醉、儿科麻醉、结果研究和并发症。这本受人尊敬的期刊出版了 30 多年，也是欧洲区域麻醉和疼痛治疗学会的官方出版物（ ESRA)、亚洲和海洋区域麻醉学会 (AOSRA)、拉丁美洲区域麻醉学会 (LASRA)、非洲区域麻醉学会 (AFSRA) 和印度区域麻醉学会 (AORA)。

Regional Anesthesia and Pain Medicine is the official journal of the American Society of Regional Anesthesia and Pain Medicine (ASRA). It is a monthly publication that features peer-reviewed scientific and clinical research aimed at enhancing the understanding and clinical application of surgical anesthesia and regional techniques for postoperative pain management. The journal covers a wide range of topics, including intraoperative regional techniques, perioperative pain management, chronic pain, obstetric anesthesia, pediatric anesthesia, outcome studies, and complications. This esteemed journal has been in publication for over 30 years and serves as the official journal for the European Society of Regional Anesthesia and Pain Therapy (ESRA), the Asian and Oceanic Society of Regional Anesthesia (AOSRA), the Latin American Society of Regional Anesthesia (LASRA), the African Society of Regional Anesthesia (AFSRA), and the Indian Society of Regional Anesthesia (AORA).

《Regional Anesthesia and Pain Medicine》是美国区域麻醉和疼痛医学协会（ASRA）的官方期刊，月刊形式，发表经过同行评审的科学和临床研究，旨在促进对手术麻醉和区域技术的理解及其在术后镇痛中的应用。期刊内容涵盖术中区域技术、围手术期疼痛管理、慢性疼痛、产科麻醉、儿科麻醉、结果研究及并发症等领域。这本享有盛誉的期刊已出版超过30年，同时也是欧洲区域麻醉和疼痛治疗学会（ESRA）、亚洲和海洋区域麻醉学会（AOSRA）、拉丁美洲区域麻醉学会（LASRA）、非洲区域麻醉学会（AFSRA）及印度区域麻醉学会（AORA）的官方出版物。

Regional Anesthesia and Pain Medicine

Background and Objectives Transversus abdominis plane block (TAPB) and rectus sheath block (RSB) are popular methods of controlling postoperative pain. Chronological changes in blood concentrations of local anesthetics have not been described, although a large amount of local anesthetic is required to block these compartments. We postulated that blood concentrations of anesthetics would peak earlier during TAPB than RSB (primary end point). Secondary end points were elapsed time from block until first postoperative rescue analgesia and affected dermatomes. Methods This prospective, randomized study included 22 patients scheduled for laparoscopic ovarian surgery under general anesthesia. The patients were randomized to receive either a bilateral single-shot TAPB or a bilateral RSB (15 mL of 0.5% ropivacaine per side). Arterial blood was sampled 10, 20, 30, 45, 60, 90, and 120 minutes after ropivacaine administration. This trial was registered at the UMIN-Clinical Trials Registry (UMIN000012133) before patient recruitment. Results Arterial ropivacaine levels after block peaked earlier in the TAPB than in RSB [Tmax: 35 (12) vs 53 (16) minutes; P = 0.02], whereas peak ropivacaine concentrations did not significantly differ between the groups [Cmax: 1.83 (0.41) vs 1.79 (0.33) &mgr;g/mL; P = 0.54]. Peak ropivacaine concentrations exceeded 2.2 &mgr;g/mL in 1 and 2 patients in the RSB and TAPB groups, respectively, although symptoms of local anesthetic systemic toxicity were not evident in any of them. The median [interquartile range] duration of analgesia was significantly longer for TAPB than RSB (421 [335–536] vs 196 [168–277] minutes; P = 0.01). Conclusions Peak ropivacaine concentrations were comparable during TAPB and RSB, but peaked earlier during TAPB. Although 150 mg of ropivacaine remained effective significantly longer during TAPB than RSB during laparoscopic surgery, this dose could cause local anesthetic systemic toxicity. The analgesic effects of blocks with less ropivacaine should be assessed.

Takeshi Murouchi

Soshi Iwasaki

Michiaki Yamakage

Chronological Changes in Ropivacaine Concentration and Analgesic Effects Between Transversus Abdominis Plane Block and Rectus Sheath Block

罗哌卡因浓度及镇痛效果在腹横肌平面阻滞与腹直肌鞘阻滞间的时序变化

This article in our series on point-of-care ultrasound (US) for the regional anesthesiologist and pain management specialist describes the emerging role of gastric ultrasonography. Although gastric US is a relatively new point-of-care US application in the perioperative setting, its relevance for the regional anesthesiologist and pain specialist is significant as our clinical practice often involves providing deep sedation without a secured airway. Given that pulmonary aspiration is a well-known cause of perioperative morbidity and mortality, the ability to evaluate for NPO (nil per os) status and risk stratify patients scheduled for anesthesia is a powerful skill set. Gastric US can provide valuable insight into the nature and volume of gastric content before performing a block with sedation or inducing anesthesia for an urgent or emergent procedure where NPO status is unknown. Patients with comorbidities that delay gastric emptying, such as diabetic gastroparesis, neuromuscular disorders, morbid obesity, and advanced hepatic or renal disease, may potentially benefit from additional assessment via gastric US before an elective procedure. Although gastric US should not replace strict adherence to current fasting guidelines or be used routinely in situations when clinical risk is clearly high or low, it can be a useful tool to guide clinical decision making when there is uncertainty about gastric contents.In this review, we will cover the relevant scanning technique and the desired views for gastric US. We provide a methodology for interpretation of findings and for guiding medical management for adult patients. We also summarize the current literature on specific patient populations including obstetrics, pediatrics, and severely obese subjects.

Stephen C. Haskins

Richelle Kruisselbrink

Jan Boublik

Christopher L. Wu

Anahi Perlas

Regional Anesthesia & Pain Medicine

Gastric Ultrasound for the Regional Anesthesiologist and Pain Specialist

Chronic neuropathic pain is a widespread problem with negative personal and societal consequences. Despite considerable clinical neuroscience research, the goal of developing effective, reliable, and durable treatments has remained elusive. The critical role played by the dorsal root ganglion (DRG) in the induction and maintenance of chronic pain has been largely overlooked in these efforts, however. It may be that, by targeting this site, robust new options for pain management will be revealed. This review summarizes recent advances in the knowledge base for DRG-targeted treatments for neuropathic pain:• Pharmacological options including the chemical targeting of voltage-dependent calcium channels, transient receptor potential channels, neurotrophin production, potentiation of opioid transduction pathways, and excitatory glutamate receptors.• Ablation or modulation of the DRG via continuous thermal radiofrequency and pulsed radiofrequency treatments.• Implanted electrical neurostimulator technologies.• Interventions involving the modification of DRG cellular function at the genetic level by using viral vectors and gene silencing methods.

Liong Liem

Eric van Dongen

Frank J. Huygen

Peter Staats

Jeff Kramer

The Dorsal Root Ganglion as a Therapeutic Target for Chronic Pain

Quadriceps sparing adductor canal block has emerged as a viable intervention to manage pain after total knee arthroplasty. Recent studies have defined ultrasound (US) landmarks to localize the proximal and distal adductor canal. US-guided proximal adductor canal injection has not been investigated using these sonographic landmarks. The objectives of this cadaveric study were to evaluate dye injectate spread and quantify the capture rates of nerves supplying articular branches to the knee joint capsule using a proximal adductor canal injection technique.
A US-guided proximal adductor canal injection with 10 mL of dye was performed in seven lightly embalmed specimens. Following injection, specimens were dissected to document dye spread and frequency of nerve staining.
Following proximal adductor canal injection, dye spread consistently stained the deep surface of sartorius, vastoadductor membrane, aponeurosis of the vastus medialis obliquus, and adductor canal. The saphenous nerve, posteromedial branch of nerve to vastus medialis, superior medial genicular nerve and genicular branch of obturator nerve were captured in all specimens at the proximal adductor canal. There was minimal to no dye spread to the distal femoral triangle, anterior division of the obturator nerve and anterior branches of nerve to vastus medialis.
This anatomical study provides some insights into the mechanism of analgesia to the knee following a proximal adductor canal injection and its motor sparing properties. Further clinical investigation is required to confirm cadaveric findings.

John Tran

Vincent W S Chan

Philip W H Peng

Anne M R Agur

Reg Anesth Pain Med

Evaluation of the proximal adductor canal block injectate spread: a cadaveric study

<h3>Background and Objectives:</h3> The longus colli (LC) muscle is an important structure of the anterior cervical spine and has a critical role in stellate ganglion block. This technique involves withdrawing the needle to locate its port for injection above the anterior surface of the LC muscle; however, its exact thickness at the C5, C6, and C7 levels has not been measured. The aim of this anatomic and magnetic resonance-supported study was to evaluate the thickness of the LC muscle at these levels from the anterior tubercle of each vertebra toward the vertebral body at 5-, 10-, and 15-mm distances to provide precise anatomic data for stellate ganglion block. <h3>Methods:</h3> Ten cadavers, 60 vertebral body specimens, and cervical magnetic resonance imaging (MRI) scans of 40 adult patients were used for measurements. <h3>Results:</h3> The main findings of this study are that the thickness of the LC muscle varies between 5.0 and 10.0 mm at C6 and C7 in cadavers and between 8.0 and 10.0 mm in MRI scans. Sex has an important role; MRI scans revealed that male patients have a considerably thicker LC muscle at each vertebral level. <h3>Conclusion:</h3> We found a highly variable thickness of the LC muscle in anatomic and imaging studies, which may lead to negative block results.

Yeşim Ateş

Ibrahim Asik

Enver Özgencil

Halil İbrahim Açar

Banu Yağmurlu

İbrahim Tekdemir

Evaluation of the Longus Colli Muscle in Relation to Stellate Ganglion Block

评估颈长肌与星状神经节阻滞的关系

We thank Girón-Arango et al for their elaborate discussion of our recent publication.[1 2][1] We would like to respond to their comments and provide further clarification on the points raised. We disagree with Girón-Arango et al 's comments regarding the 'Rashomon effect'. Conflicting

Angela Lucia Balocco

Admir Hadzic

Philippe Emmanuel Gautier

A response to Rashomon perspectives in PENG block

对PENG区块罗生门视角的回应

Background Intrathecal drug delivery (IDD) is a well-established treatment modality for refractory chronic pain. Intrathecal catheter-tip granuloma (ICTG) formation is a known possible complication of opiate IDD and is likely triggered by mast cell degranulation. The use of low concentration and dosage of opioids that do not induce mast cell degranulation has been advised to mitigate the risk of ICTG formation. Case presentation A patient in their 50s with history of multiple lumbar spine surgeries and refractory low back pain who was treated with IDD developed an initial ICTG while receiving intrathecal hydromorphone and bupivacaine. The patient’s catheter was thus replaced and repositioned. The pump was also replaced due to repeat motor stall, and the infusate was changed from hydromorphone with bupivacaine to low-dose fentanyl with bupivacaine. Five years later, the patient developed myelopathic symptoms, and on imaging a new mass believed to be an ICTG was detected at the new thoracic catheter tip location. The patient was placed on normal saline infusion for 4 months before system explant, with some improvement of symptoms. Conclusions ICTG formation is uncommon but can be a devastating complication of IDD if not properly diagnosed in a timely fashion. Repeat ICTG has only been documented twice in the literature, and ICTG with low dose fentanyl in combination with bupivacaine has not been reported. Despite using regimens and techniques to reduce the risk of ICTG formation, one must judiciously surveil their patients for the dreaded ICTG complication.

Timothy V Feldheim

Salim M Hayek

Recurrent intrathecal catheter-tip granuloma formation on a replaced system delivering low dose/concentration fentanyl and bupivacaine: a case report

反复硬膜外导管尖端肉芽肿形成于替换系统输注低剂量/浓度芬太尼和布比卡因：一例报告

Background There is paucity of data from randomized controlled trials supporting the use of peripheral nerve stimulation, a well-established therapy for the treatment of chronic pain. This study was undertaken, in part, to provide randomized controlled trial data in support of patient access to appropriate peripheral nerve stimulation therapy. The COMFORT study is the first large, postmarket, multicenter randomized controlled trials investigating the use of a Food and Drug Administration-cleared micro-implantable pulse generator (IPG) for treating chronic pain via peripheral nerve stimulation therapy. Methods Consented, eligible subjects were randomized to either the active arm, which received peripheral nerve stimulation and conventional medical management, or the control arm, which received conventional medical management alone and were allowed to cross over to the active arm, after 3 months. Pain and patient-reported outcomes were captured. Therapy responders were subjects who achieved at least a 50% reduction in pain scores compared with baseline. We are reporting the 12-month results of this 36-month study. Results At 12 months, the responder rate was 87% with a 69% average reduction in pain compared with baseline (7.5±1.2 to 2.3±1.7; p&lt;0.001). Statistical significance was achieved for all patient-reported outcomes. There was an excellent safety profile with no serious adverse device effects or reports of pocket pain. A majority of subjects used unique programming options and found this device easy to use and comfortable to wear. Conclusions These 12-month results are consistent with previously reported 6-month outcomes from this study, showing durability of peripheral nerve stimulation treatment with the micro-IPG system; subjects realized sustained large reduction in pain and improvement in patient-reported outcomes following treatment with this micro-IPG system. Trial registration number NCT05287373 .

John Hatheway

Alexander Hersel

Mitchell Engle

Genaro Gutierrez

Vishal Khemlani

Leonardo Kapural

Gregory Moore

Reginald Ajakwe

Drew Trainor

Jennifer Hah

Peter S Staats

James Makous

Gary Heit

Shilpa Kottalgi

Mehul J Desai

Clinical study of a micro-implantable pulse generator for the treatment of peripheral neuropathic pain: 12-month results from the COMFORT-randomized controlled trial

微植入式脉冲发生器治疗周围神经性疼痛的临床研究：COMFORT随机对照试验12个月结果

Background Postamputation pain (PAP) is underexplored in East Asian populations, with most data originating from Western countries. This study aimed to investigate the prevalence and risk factors of PAP in East Asian individuals who underwent surgical amputation, particularly those requiring subsequent analgesia or nerve interventions. Materials and methods The study used data from the Longitudinal Health Insurance Database, encompassing claims from 2 million randomly selected individuals out of 23.5 million enrolled in Taiwan’s National Health Insurance Research Database from 2000 to 2019. The risk factors for PAP were analyzed using multivariable regression, considering criteria such as chronic postamputation pain, symptomatic neuroma treatment, chronic analgesia use, and nerve interventions. Results Among the 7287 amputees (mean age 59.5 years; 65.1% male), 18.1% (95% CI 17.2%, 19.0%) (1318 patients) experienced PAP requiring intervention. Significant risk factors included cancer (OR 2.20 (95% CI 1.27, 3.68)), peripheral artery disease (OR 2.11 (95% CI 1.66, 2.69)), infection (OR 1.93 (95% CI 1.55, 2.40)), diabetes mellitus (OR 1.85 (95% CI 1.45, 2.37)), and a higher Elixhauser Comorbidity Index (OR 1.04 (95% CI 1.02, 1.06)). Prior radiculopathy (OR 1.30 (95% CI 1.13, 1.51)) and myelopathy (OR 1.33 (95% CI 1.14, 1.55)) also increased pain odds, while age showed a slight inverse association (OR 0.99 (95% CI 0.98, 0.99)). Conclusion The prevalence of PAP requiring subsequent analgesia or nerve interventions in this East Asian population is 18.1%. Identified risk factors include multiple medical comorbidities and pre-existing radiculopathy or myelopathy. These findings highlight the important considerations for both clinical practice and future research directions.

Wen-Chih Liu

Fu-Wei Su

Sheng-You Su

Chen-Hao Chiang

Shu-Hsin Yao

Chia-Lung Shih

Kyle R Eberlin

Prevalence and risk factors for chronic postamputation pain requiring analgesia or nerve interventions: a population-based study in East Asia

东亚地区慢性截肢后疼痛的流行率及需要镇痛或神经介入治疗的风险因素：一项基于人群的研究

Background Clinical studies suggest that long-term conventional spinal cord stimulation (LT-SCS) for painful diabetic peripheral neuropathy (PDPN) is initially effective but may decline in efficacy over time. Preclinical studies indicate that LT-SCS alleviates mechanical hypersensitivity and enhances hind paw blood flow in PDPN rats, suggesting nociceptive system plasticity. This study hypothesized that LT-SCS induces peripheral hind paw small-fiber sprouting and reduces central protein expression of glial and P2X4 brain-derived neurotrophic factor (BDNF) pathway markers. Methods Diabetes was induced via Streptozotocin injection in 32 rats, with 16 developing PDPN and receiving a quadrupolar lead implant. LT-SCS was applied for 4 weeks, 12 hours per day. Pain behavior was assessed using the Von Frey test for mechanical hypersensitivity and the mechanical conflict avoidance system for motivational aspects of pain. Fiber sprouting was assessed via immunohistochemical analysis of nerve fibers in the hind paw skin. Protein expression in the spinal cord was assessed using western blotting. Results LT-SCS increased the baseline threshold of mechanical hypersensitivity in PDPN animals, consistent with previous findings, but showed no effects on motivational aspects of pain. Hind paw tissue analysis revealed significantly increased intraepidermal nerve fiber density of PGP9.5 fibers in LT-SCS animals compared with Sham-SCS animals. Protein analysis showed significantly decreased pro-BDNF expression in LT-SCS animals compared with Sham-SCS animals. Conclusion LT-SCS induces structural changes in both peripheral and central components of the nociceptive system in PDPN animals. These changes may contribute to observed behavioral modifications, elucidating mechanisms underlying LT-SCS efficacy in PDPN management.

Thomas de Geus

Glenn Franken

Xander Zuidema

Jan van Zundert

Elbert A J Joosten

Structural changes in the nociceptive system induced by long-term conventional spinal cord stimulation in experimental painful diabetic polyneuropathy

实验性痛性糖尿病多发性神经病变中长期传统脊髓刺激引起的痛觉系统结构变化

Abbreviation	Reg Anesth Pain Med
Journal Impact	5.20
Quartiles(Global)	ANESTHESIOLOGY(Q1)

ISSN	0146-521X, 1098-7339, 1532-8651, 2331-4613
h-index	124

Publication Information	Publisher: BMJ Publishing Group，Publishing cycle: ，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 1998，Proportion of original research papers: ，Self Citation Rate:， Gold OA Rate:

Regional Anesthesia and Pain Medicine

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