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Regional Anesthesia & Pain Medicine

RAPM is your authoritative medical source for regional anesthesia and pain knowledge – from pediatric

11/10/2025

🩸 NEW ASRA GUIDELINES 🩸

The 5th Edition of ASRA Pain Medicine’s Evidence-Based Guidelines on the use of Antithrombotic and Thrombolytic and Regional Anesthesia introduces key updates:

✅ More conservative interruption times for some anticoagulants.
✅ Updated dose classification: now defined as "low" and "high" instead of "prophylactic" and "therapeutic."
✅ New recommendations for the use of anticoagulant-specific laboratory tests.

These updates aim to improve clinical decision-making and reduce the risk of hemorrhagic complications in neuraxial and deep plexus blocks.

📖 Don’t miss the latest updates! Read the full guidelines (for free) here: https://doi.org/10.1136/rapm-2024-105766

11/07/2025

🎧 NEW RAPM FOCUS DROP — For Future and Current Regionalists! 💥
Regional Anesthesiology Fellowships & Their Significance

Now streaming 🎙️

💡 Fellowship applications have declined in recent years — but what does this mean for the future of regional anesthesia?

🧠 In this episode:
✔️ Why regional fellowships remain invaluable despite a competitive job market
✔️ How training shapes practice and innovation in the field
✔️ Insightful perspectives from two experts with different career paths

🎙️ Featuring:
👩‍⚕️ Dr. Meredith Peck, Regional Anesthesia & Pain Medicine Fellow, Dartmouth-Hitchcock Medical Center
👩‍⚕️ Dr. Gisselle Maquoit, Anesthesiologist, Kennebec Anesthesia Associates (Regional Fellowship at Duke University)

🎧 Listen now on RAPM Focus
🔗 https://rapm.bmj.com?utm_campaign=facebook&utm_content=%F0%9F%8E%A7+NEW+RAPM+FOCUS+DROP+%E2%80%94+&utm_source=Regional+Anesthesia+%26+Pain+Medicine

11/05/2025

SPACE-Postpartum: redefining recovery after cesarean delivery 🤰🏼

💉 Chronic postsurgical pain after cesarean affects up to 17% of women, but most prediction models focus only on clinical or demographic factors.

This RAPM proof-of-concept report introduces SPACE-Postpartum, a multidomain, symptom-based framework integrating:

🛌 Sleep disturbance
💥 Pain burden
💭 Affective distress
🧠 Cognitive disruption
⚡ Energy (fatigue)

📑 Developed through qualitative interviews, cohort analyses, and literature synthesis, SPACE-Postpartum demonstrated feasibility for early multidomain risk stratification after cesarean delivery.

😷 This patient-centered model moves beyond pain intensity to capture how interconnected symptoms shape long-term recovery—paving the way for personalized, mechanism-informed postpartum care.

👉 Full paper: https://doi.org/10.1136/rapm-2025-107149

$Multimodal analgesia (MMA) in geriatric hip fracture: less pain, fewer opioids, faster mobilization 🦴💊📑 A single-center ...$

11/03/2025

Multimodal analgesia (MMA) in geriatric hip fracture: less pain, fewer opioids, faster mobilization 🦴💊

📑 A single-center before–after cohort with propensity score matching (280 vs 280) evaluated a standardized MMA protocol (acetaminophen-based regimen, preference for spinal anesthesia, and routine regional nerve blocks). Key findings:

✅ Pain ↓ at 6h, 24h, 48h after surgery (no change at 12h)
✅ Opioids ↓ at 48h (≈5.5 vs 13.3 mg oral morphine equivalents)
✅ Earlier wheelchair ambulation (≈1.3 vs 2.1 days)
ℹ️ Delirium is higher in MMA era (likely impacted by systematic screening)

📈 Trends confirmed via SPC charts showing sustained improvement post-implementation

⚠️ Implication: Standardized MMA can improve early recovery while reducing opioid exposure in older hip-fracture patients.

🔗 Full paper: https://doi.org/10.1136/rapm-2025-106781

10/21/2025

🚨 A NOVEL DEVICE COMBINING LOCAL ANESTHESIA AND NEUROMODULATION

Could this represent the next evolution in postoperative pain management?
In this pilot feasibility study, Ilfeld et al. tested a percutaneous device (RELAY, Gate Science) capable of delivering:

1️⃣ a single injection nerve block
2️⃣ a continuous perineural infusion
3️⃣ and electrical stimulation of the target nerve—for up to 28 days.

📊 Key findings
• Median daily pain: NRS 2 (0–3)
• 85 % discharged on postoperative day 0
• No serious device-related adverse events
• Median opioid use week 1: 43 mg oxycodone
💡 This hybrid approach could shift how we treat postoperative pain—extending analgesia while reducing opioid use.

🔗 READ the full study -> https://doi.org/10.1136/rapm-2025-107029

10/19/2025

🤖✨ Establishing Guardrails for AI in Medical Research ✨🤖

AI tools like ChatGPT and Grammarly are reshaping how research is written and reviewed. But where’s the line between helpful innovation and scientific risk?

📚 A new RAPM consensus outlines clear guidelines for using AI responsibly in medical publishing — promoting transparency while preserving rigor and creativity.

💡 Takeaway: AI can assist, but disclosure and integrity are essential.

READ HERE -> https://doi.org/10.1136/rapm-2025-106979

10/18/2025

🔬 Phentolamine: More Than an α-Blocker?

📚 New research shows phentolamine, known for vascular use, preferentially blocks C-fibers—the nerves that drive pain and itch—across mice, pigs, and humans.

💡 Why it matters:
- Potential tool for studying pain pathways
- Could lead to new C-fiber-targeted pain & itch treatments.

READ HERE -> https://doi.org/10.1136/rapm-2025-106791

10/17/2025

🚨 CRYSTALS IN THE MIX: UNEXPECTED CHEMISTRY OF LOCAL ANESTHETICS

What happens inside your syringe when lidocaine meets ropivacaine and bicarbonate? 💉

In this original research, Gasteiger et al. analysed eight local anesthetic and adjuvant mixtures.

💎 Crystallization appeared in lidocaine + NaHCO₃ and lidocaine + ropivacaine + NaHCO₃ — both forming pure local anesthetic crystals, yet drug concentrations remained stable.

🔍 These findings raise new questions about compatibility and in-vivo behaviour.

📚 READ HERE -> https://rapm.bmj.com/content/early/2025/09/25/rapm-2025-106981?utm_campaign=facebook&utm_content=%F0%9F%9A%A8+CRYSTALS+IN+THE+MIX%3A+U&utm_source=Regional+Anesthesia+%26+Pain+Medicine

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