Regional Anesthesia & Pain Medicine

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Regional Anesthesia & Pain Medicine

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

05/27/2026

🚨 Sub-perception dorsal root ganglion stimulation vs sham stimulation in established responders

📚 A new randomized, double-blind crossover clinical trial examined subperception (paresthesia-free) dorsal root ganglion (DRG) stimulation versus sham stimulation in established DRG responders with chronic neuropathic or nociplastic pain.

Key findings:
🔹 Active subperception DRG stimulation significantly reduced pain compared with sham stimulation
🔹 Improved patient satisfaction and PGIC outcomes
🔹 No serious or device-related adverse events reported

✅ These findings provide important sham-controlled evidence supporting the efficacy of subperception DRG stimulation during the maintenance phase of chronic pain treatment.

LINK -> https://doi.org/10.1136/rapm-2026-107906

05/20/2026

🚨 Preoperative vitamin D level and postoperative pain in patients undergoing breast cancer surgery

🔬 A new prospective observational study published in RAPM found that preoperative vitamin D deficiency was associated with:
🔹 Higher postoperative pain scores
🔹 Increased opioid consumption
🔹 Greater likelihood of moderate-to-severe pain after breast cancer surgery

📈 In patients undergoing unilateral modified radical mastectomy, vitamin D deficiency independently increased the odds of significant postoperative pain during the first 24 hours (adjusted OR 3.12).

💡 These findings highlight the potential importance of preoperative nutritional and metabolic optimization in perioperative pain management.

READ HERE -> https://doi.org/10.1136/rapm-2025-107495

05/18/2026

🎙️ New RAPM Focus Podcast Episode

In Episode 51 of RAPM Focus, RAPM Social Media Editor Alopi Patel, MD, speaks with Sesh Mudumbai, MD, MS, and Oluwatobi “Tobi” Hunter, DNP, RN-BC, AGACNP-BC, about their recent study:

“Utilization and opioid outcomes of a transitional pain service in high-risk surgical veterans: a cohort study.”

This discussion explores:
🔹 Transitional pain services in high-risk surgical veterans
🔹 Opioid outcomes and perioperative pain management
🔹 Multidisciplinary approaches to improving surgical recovery and long-term outcomes

💡 An insightful conversation on perioperative care, pain trajectories, and innovative models in pain medicine.

🎧 Listen here -> https://rapmfocusbmj.podbean.com/e/episode-51-utilization-and-opioid-outcomes-of-a-transitional-pain-service-in-high-risk-surgical-veterans-a-cohort-study/

05/05/2026

📊 Can early postoperative pain predict long-term recovery after knee replacement surgery?

This study applied machine learning to a large cohort of 17,200 total knee arthroplasty patients to better understand postoperative pain patterns.

⚡️ Key findings:
• Two distinct pain trajectories were identified:
– Low pain trajectory
– High pain trajectory
• The high pain group showed:
– Higher pain scores
– Greater opioid consumption
– Increased need for pain consultations
• A predictive model achieved:
– 64% accuracy
– Moderate discrimination in identifying high-risk patients

💡 The most important insight:
Pain patterns within the first 12–24 hours after surgery already provide meaningful information about future pain trajectories.

📈 Why this matters:
• Moves beyond isolated pain scores → captures dynamic pain evolution over time
• Enables early risk stratification
• Opens the door to targeted, proactive pain management strategies

⚠️ Reality check:
Prediction is still moderate — but this is a proof of concept for scalable clinical tools using electronic health record data.

‼️ Bottom line:
We are moving from reactive pain control to early identification and intervention.

🔗 https://doi.org/10.1136/rapm-2026-107626

05/04/2026

⚡️ From electrical dose to neural dose: redefining spinal cord stimulation
This study investigates whether dorsal column activation—measured via evoked
compound action potential threshold (ECAPT)—drives analgesia in spinal cord stimulation (SCS).

🔍 What they did:
Rats with neuropathic pain received SCS at doses based on ECAP threshold (ECAPT):
• Subthreshold: 0–0.5×ECAPT
• Suprathreshold: 1.1–1.4×ECAPT (closed-loop)

‼️ Key findings:
✅ Only suprathreshold doses (≥1.1×ECAPT) produced analgesia
✅ 1.2–1.3×ECAPT provided the most sustained pain relief
⚠️ 1.1×ECAPT showed reduced efficacy
⚠️ 1.4×ECAPT offered no additional benefit
❌ Subthreshold stimulation (≤0.5×ECAPT) was ineffective

💡 Why this matters:
Traditional SCS dosing relies on electrical output or motor thresholds, which poorly reflect actual neural activation.

📊 This study demonstrates that:
• Analgesia is directly linked to dorsal column recruitment
• ECAP threshold (ECAPT) is a clinically relevant, objective dosing marker
• Closed-loop systems can maintain consistent neural activation despite physiological variability

📈 The big picture:
This work identifies a therapeutic window for SCS and supports ECAP-guided dosing as a translational bridge between preclinical and clinical practice.

🔗 https://doi.org/10.1136/rapm-2026-107607

05/01/2026

📊 Can an axillary approach improve axillary nerve blocks?

In this cadaveric study, investigators evaluated an ultrasound-guided axillary approach to axillary nerve block and assessed injectate location and spread.

Key findings:
✅ Axillary nerve identified in all specimens
✅ Blue latex consistently targeted the bifurcation of axillary nerve branches
✅ Methylene blue spread covered all major motor branches in all specimens
✅ Mean injection location was 0.96 cm from the branch bifurcation
✅ The approach avoided reliance on identifying the posterior circumflex humeral artery, a common limitation of posterior approaches

💡 Why this matters:
This technique may provide a simpler alternative to conventional posterior ANB, particularly when used alongside suprascapular nerve block as a phrenic-sparing alternative to interscalene block.

✨ The takeaway:
The axillary approach may offer reliable branch coverage with favorable sonographic accessibility, supporting future clinical evaluation.

🔗 Read the full study:
https://doi.org/10.1136/rapm-2025-107503

04/30/2026

📊 Can a trans-quadrangular space approach improve axillary nerve blockade?
This cadaveric simulation study evaluated a novel ultrasound-guided TQS approach to selective axillary nerve blockade.

⚠️ Key findings:
✅ Main axillary nerve trunk stained in 100% of injections
✅ Anterior division stained in 83%
✅ Posterior division stained in 90%
✅ Minimal unintended spread
• Radial nerve lightly stained in 25%
• No musculocutaneous or posterior cord staining

💡 Why this matters:
This posterior technique targets the nerve within the quadrangular space rather than after exit from it, potentially improving articular branch coverage while supporting phrenic-sparing shoulder analgesia.

- Additional practical advantage:
✔ Performed in lateral position without shoulder abduction, potentially useful in painful or mobility-limited patients.

✨ The takeaway:
The TQS approach demonstrated anatomical feasibility, selective spread, and may warrant clinical evaluation as a novel axillary nerve block technique.

🔗 Read the full study:
https://doi.org/10.1136/rapm-2026-107774

04/23/2026

🔍 Debunking myths in facial pain diagnosis

Facial pain—especially trigeminal neuralgia—remains frequently misdiagnosed, leading to ineffective treatments and prolonged suffering.

A recent ASRA multidisciplinary paper in RAPM highlights common misconceptions that can misguide diagnosis and management.

Key points:
⚠️ Facial pain diagnosis is often clouded by training myths
🧠 MRI is not routine—reserved for suspected trigeminal neuralgia
📌 Neurovascular compression ≠ diagnosis (only helps guide MVD planning)
🎯 Diagnosis is clinical first—not imaging-driven

Bottom line:
Getting the diagnosis right is the most important step in avoiding unnecessary procedures and improving outcomes.

👉 A strong reminder: treat the patient, not the scan

🔗 https://doi.org/10.1136/rapm-2025-107382

04/21/2026

🔍 Plain vs hyperbaric bupivacaine—does baricity impact spinal anesthesia in TKA?

A recent randomized, double-blinded trial compared plain vs hyperbaric 0.5% bupivacaine for spinal anesthesia in total knee arthroplasty.

Key Findings:
📉 Similar maximal MAP drop (~33% in both groups)
📊 No difference in nadir BP or hemodynamic trends
🤢 Comparable nausea/vomiting and vasopressor use
⏱️ No group effect over the first hour post-spinal

Takeaway:
At 10 mg intrathecal dose, plain and hyperbaric bupivacaine performed similarly for early hemodynamic stability.

👉 Baricity alone may not meaningfully influence hypotension risk in this setting.

🔗 https://doi.org/10.1136/rapm-2025-107546

04/20/2026

🫀 Regional anesthesia in pediatric cardiac surgery—does it help?

A RAPM meta-analysis (31 RCTs, n=2245) found 👇

⬇️ Opioid use (intraop + 24h)
⏱️ Faster extubation + ↓ ICU stay
⏳ Longer time to first analgesia

But…
⚠️ Evidence = low quality
⚠️ High variability between studies

Bottom line:
👉 Promising, but far from definitive

🔗 https://doi.org/10.1136/rapm-2025-107470

04/17/2026

🔍 PENG block for hip arthroscopy—worth it?

A recent RCT in RAPM looked at preop PENG block for ambulatory hip arthroscopy 👇

What they found:
❌ No improvement in 24h opioids or QoR
⏱️ ↓ PACU opioids + shorter PACU stay
⚖️ No difference in pain, 48h opioids, or side effects

Bottom line:
👉 Limited early benefit, no impact on overall recovery
👉 Not ready for routine use—but may help select patients in PACU

📌 Postop (rescue) PENG block = area to watch

🔗 https://doi.org/10.1136/rapm-2026-107706

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