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

08/11/2025

🌟 Meet RAPM Associate Editor – Dr. Julián Aliste 🌟

Dr. Julián Aliste is an Associate Professor of Anesthesiology at Montreal General Hospital & McGill University, specializing in regional anesthesia and acute pain.

💬 “I thrive on the challenge of managing complex trauma and thoracic cases that demand advanced anesthetic expertise.”

His RAPM journey began in 2017 when Dr. Marc Huntoon invited him to join as a reviewer. Since then, he’s sharpened his research, teaching, and mentorship skills—and earned recognition as a top RAPM reviewer.

⚡ One word to describe him: Persevering
🏞 Outside work: Family, sports, books & movies

We’re proud to have him on our editorial team!

CLICK HERE 👉 https://bit.ly/46Qjgcs

08/10/2025

📊 Expert Guidance on Gastric POCUS for Aspiration Risk

A new ASRA Pain Medicine narrative review provides practice recommendations for gastric point-of-care ultrasound (POCUS) in medically complex patients undergoing regional anesthesia and pain procedures.

✅ Support: Diabetes, active labor, urgent C-sections
✅ Conditional support: Obesity, emergency care, enteral feeding, GLP-1 agonist use
❌ Not supported: Routine use in GERD, non-laboring pregnancies, elective C-sections

💡 Why this matters:
Aspiration is a significant safety concern in anesthesia. Gastric POCUS, when applied selectively, can provide valuable insight into aspiration risk and guide patient-centered care.

✨ Takeaway:
Gastric POCUS should complement—not replace—clinical judgment, offering tailored risk assessment in complex patients.

🔗 Read the full article: https://doi.org/10.1136/rapm-2025-106926

08/06/2025

📊 What’s the Best Multimodal Analgesia Strategy After Surgery?

In a study of 23,238 elective non-cardiac surgeries, researchers used instrumental variable analysis to identify optimal MMA regimens.

✅ NSAIDs + dexamethasone or NSAIDs + regional anesthesia provided the greatest reductions in postoperative opioid use
✅ MMA overall: 6.8 fewer OMEs in inpatients, 1-point lower pain scores in outpatients
❌ Acetaminophen—the most used agent—showed limited added benefit

💡 Why this matters:
Targeting the most effective MMA combinations allows us to reduce opioid reliance while improving patient recovery and safety.

✨ The takeaway:
NSAIDs and dexamethasone may be the cornerstone of effective MMA protocols, challenging the routine inclusion of intravenous acetaminophen.

🔗 Read the full study: https://doi.org/10.1136/rapm-2025-106720

08/05/2025

📣 ⚠️ FIRST-EVER guideline on Infection Control for Regional Anesthesia and Pain Medicine

Is it the end of controversies? Why don't you find out!

Read this work led by Dr. David Provenzano here: https://bit.ly/40PKgnG
Infographic here: https://doi.org/10.1136/rapm-2025-106770

08/01/2025

🔍 Genicular Nerve RFA: Where Do We Stand?

Chronic knee pain is common—and genicular nerve radiofrequency ablation (RFA) is gaining traction as a treatment. But is it effective?

📉 Some studies show lasting relief, while others raise doubts.
This new RAPM article explores key controversies:
🧠 Prognostic blocks
🎯 Nerve targets
📍 Imaging guidance
⚡ Pulsed vs. conventional RFA
🤖 Post-TKA use

📖 CLICK -> https://doi.org/10.1136/rapm-2025-106518

07/30/2025

💭 Should we trial before peripheral nerve stimulation implantation?

This new multicenter study compares two strategies for peripheral nerve stimulation in chronic pain:

🔁 Temporary to permanent
➡️ Direct to permanent

📊 What they found:
▪️ Similar pain relief at 6 months
▪️ No significant difference in opioid reduction
▪️ Comparable adverse events and explantation rates

📌 Implication: With careful patient selection, a direct to permanent approach may be just as effective while reducing procedural burden and cost.

💬 How do you approach peripheral nerve stimulation implantation in your practice? Would you consider skipping the trial phase? Join the conversation below.

🔗 Read the full open-access article now in Regional Anesthesia & Pain Medicine
👉 https://doi.org/10.1136/rapm-2025-106734

07/28/2025

Which combinations of non-opioid medications work best to reduce pain and opioid use after surgery?

This new RAPM study analyzed over 23,000 surgeries using a quasi experimental design and found:

✅ NSAIDs + dexamethasone led to the greatest reduction in pain and opioid use
⚠️ Acetaminophen had minimal effect, despite widespread use
💡 IV analysis helped emulate randomization in a real world setting

📖 Explore the full open-access article to rethink your MMA protocols:
👉 https://doi.org/10.1136/rapm-2025-106720

07/25/2025

🧠 Gabapentin and dementia: time for a second look?

A new cohort study in Regional Anesthesia & Pain Medicine found that adults with chronic low back pain who were prescribed gabapentin had significantly higher risks of both dementia and mild cognitive impairment especially those under 65 years of age.

📌 Highlights:
▪️ Dementia risk ↑ 29% overall
▪️ In patients aged 18–64, dementia risk more than doubled
▪️ Higher prescription frequency → higher risk

⚠️ These findings challenge the long held perception of gabapentin as a “safe” alternative to opioids.

🧠 Are we overlooking a hidden risk in pain management?
Do you screen for cognitive decline in patients prescribed gabapentin?
👉 Share this with your team and let us know how you approach this in your practice.

📖 Full study: https://doi.org/10.1136/rapm-2025-106577

07/23/2025

🔍 Lost in conversion: What Happens When the Math Doesn’t Add Up?

A new case report in RAPM explores the complex and often risky transition from intrathecal to oral opioids.

📌 Key takeaways:
▪️ The widely cited 1:300 conversion ratio may be dangerously outdated
▪️ Real life reconversion ratios ranged from 1:2 to 1:12
▪️ The case underscores the importance of individualized tapering strategies

🧪 Fascinating clinical insights + literature review = essential reading for any clinician managing patients with IDDS.

💬 Have you ever questioned the 1:300 ratio? Let us know in the comments!

📚 Read the full article to explore safe strategies for opioid reconversion https://doi.org/10.1136/rapm-2025-106550

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07/21/2025

🔍 Can artificial intelligence really support clinical decision making in regional anesthesia?

A new study in Regional Anesthesia & Pain Medicine put four popular AI chatbots to the test ChatGPT, Gemini, CoPilot, and OpenEvidence across real patient scenarios.

📌 Here’s what the researchers found:
⚠️ Weak clinical judgment, especially in complex cases
🧠 Hallucinations, outdated info, and unsafe recommendations
📉 No clarifying questions asked; some responses contradicted ASRA guidelines
🔍 Inconsistent citations, responses varied when re-asked the same question

💡 Bottom line:
LLMs are not yet reliable enough to act as “e-Consults” in regional anesthesiology but the study highlights where future improvements are needed.

📖 Read the full article in RAPM:
👉 https://doi.org/10.1136/rapm-2025-106850

07/20/2025

🚫💉Can skipping opioids during breast cancer surgery actually reduce inflammation? 👀

📢 New RCT in RAPM compares:
🔹 Opioid-Free General Anesthesia + Locoregional Blocks (OfGA)
vs.
🔹 Traditional Opioid-Based GA

🧪 Key Takeaways:
✅ Lower inflammation in the OfGA group (measured by neutrophil-to-lymphocyte ratio + cytokines)
✅ Similar pain control
✅ Fewer side effects with OfGA 🙌

💡 A promising step toward opioid-sparing strategies that don’t compromise comfort — and may even impact recovery + cancer biology long term.

🔗 https://doi.org/10.1136/rapm-2025-106504

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