Regional Anesthesia & Pain Medicine

02/12/2026

🎙️ CACB Beyond the OR: Rethinking Outpatient TKA

📚 RAPM Social Media Editor Alopi Patel, MD, speaks with Josh Gleicher, MD, MSc, FRCPC, and Hermann dos Santos Fernandes, MD, PhD, about their September 2025 RCT on outpatient continuous adductor canal block (CACB) for total knee arthroplasty.

They discuss study design, outpatient TKA implications, and practical CACB insights from experts at Mount Sinai Hospital and the University of Toronto.

🦻🏼 https://rapmfocusbmj.podbean.com/e/episode-47-outpatient-continuous-adductor-canal-block-cacb-for-total-knee-arthroplasty-a-double-blinded-randomized-placebo-controlled-trial/

Kick off 2026 with the January episode of RAPM Focus, where RAPM Social Media Editor Alopi Patel, MD, converses with Josh Gleicher, MD, MSc, FRCPC, and Hermann dos Santos Fernandes, MD, PhD, following the September 2025 publication of their original research paper, “Outpatient continuous adductor ...

02/09/2026

NOW OPEN: 2026 RAPM Editorial Board Applications!
Apply here: https://www.cognitoforms.com/ASRA/_2026RAPMEditorialBoardApplication

02/08/2026

🧠 ASRA Practice Advisory: Intravenous Management of Headache in Hospitalized Patients

Hospitalized patients with refractory headache present unique clinical challenges, yet evidence-based inpatient guidance has been limited. In this ASRA Pain Medicine practice advisory, experts reviewed the literature and reached consensus recommendations using a modified Delphi approach.

✅ 12 statements and 17 recommendations achieved high consensus
✅ Evidence certainty was largely low to moderate
✅ Multiple IV therapies may be considered depending on patient context

💡 Why this matters:
This is the first comprehensive effort to standardize inpatient headache management, while transparently acknowledging gaps in evidence.

✨ The takeaway:
Clinicians now have a structured, consensus-based framework for IV headache therapies in hospitalized patients—and a clear research agenda moving forward.

🔗 Read the full advisory: https://doi.org/10.1136/rapm-2025-106718

02/06/2026

🩺 Before the Scalpel: Substance Use & Recovery Pain

A new study in RAPM found that 42% of surgical patients screened positive for unhealthy substance use before surgery using the TAPS questionnaire.

📊 Patients with positive screens reported higher pain levels before surgery and at 1 month post-op, highlighting the perioperative period as a key opportunity to identify risk and support recovery.

💡 Brief screening tools like TAPS may help personalize perioperative care and improve outcomes.

🔗 https://doi.org/10.1136/rapm-2025-107259

02/05/2026

🩺 Reassessing QTc Risk in Perioperative Methadone

📖 As methadone use increases for postoperative pain control, concerns about QTc prolongation persist. A new study in Regional Anesthesia & Pain Medicine found that intraoperative methadone was not associated with increased QTc prolongation compared with non-methadone patients during major surgery.

📊 QTc >500 ms and significant QTc increases occurred at similar rates across groups—supporting safer, evidence-based perioperative pain management.

🔗 https://doi.org/10.1136/rapm-2025-107331

02/03/2026

🧠 Inpatient Management of Refractory Headache

📚 New RAPM practice advisory fills a major gap in inpatient headache care—offering 12 consensus statements and 17 graded recommendations on IV therapies based on expert review and Delphi consensus.

📊 Plus, a clear infographic highlighting key safety tips and best practices for commonly used IV agents.

🔗 https://doi.org/10.1136/rapm-2026-107605

02/01/2026

🧠 Do corticosteroid dose and injection site really matter in facet and sacroiliac joint pain?

This multisociety, multispecialty consensus provides evidence-based recommendations on the safe and effective use of corticosteroid injections for facet joint and sacroiliac joint pain.

✨ Key points:

• Intra-articular facet joint injections may benefit selected patients with inflammatory pain
• Recommended dose for facet joint injections: ≤10 mg methylprednisolone or triamcinolone per joint
• For sacroiliac joint injections, intra-articular, extra-articular, or combined approaches are effective
• Image guidance (fluoroscopy or CT) is strongly recommended
• Repeated injections should be guided by clinical response, not routine schedules

🔍 Clinical relevance:
These recommendations emphasize patient selection, minimal effective dosing, and timing based on pain recurrence (>50% of baseline) to optimize outcomes while minimizing systemic corticosteroid exposure.

📖 Benzon HT et al.

👉 Read the full article in RAPM: https://doi.org/10.1136/rapm-2025-107347

01/31/2026

🫁 Troubleshooting pitfalls in gastric ultrasound

Gastric point-of-care ultrasound is widely used to assess gastric content and aspiration risk, but not all exams are straightforward.

This educational article reviews common pitfalls that can lead to indeterminate or misleading findings during gastric ultrasound assessment.

✨ Key points:
• Up to 5% of gastric ultrasound exams may be inconclusive
• Common errors include misidentification of the gastric antrum
• Clear guidance on differentiating the antrum from colon, gallbladder, and small bowel
• Practical troubleshooting strategies to improve image interpretation
• Alternative scanning windows when the antrum is not visualized

🔍 A practical, image based guide to improve accuracy and patient safety at the bedside.

📖 Cheng P et al.

👉 Read the full article in RAPM: https://doi.org/10.1136/rapm-2025-107362

01/29/2026

🦵 Should genicular nerve targets be modified after total knee arthroplasty?

This cadaveric study compares native vs prosthetic knees to assess whether anatomical targets for genicular nerve radiofrequency ablation need adjustment after TKA.

✨ Key points:

• Genicular nerve landmarks were largely similar in native and prosthetic knees
• Prosthetic knees showed smaller nerve diameters
• Fibrosis of the infrapatellar branch of the saphenous nerve was frequently observed
• Vascular landmarks were inconsistent for some targets, especially the superolateral genicular nerve

🔍 Anatomical differences alone may not fully explain the reduced effectiveness of genicular nerve RFA after TKA, but they likely influence targeting accuracy and outcomes.

📖 Fodjeu Gaspary et al.

👉 Explore the anatomy behind genicular nerve RFA in RAPM: https://doi.org/10.1136/rapm-2025-107379

01/26/2026

🧬 Do Peripheral Nerve Block Adjuvants Directly Affect Nerve Fibers?

This experimental study used ex vivo rat sciatic nerve electrophysiology to evaluate the effects of dexmedetomidine, magnesium, epinephrine, and ketorolac on peripheral nerve fiber activity, with and without bupivacaine.

✅ Fiber-specific EC50s were identified for all four adjuvants
✅ Dexmedetomidine affected A-alpha/beta, A-delta, and C fibers
✅ Magnesium primarily affected A-delta fibers
✅ Epinephrine showed effects on C fibers
✅ Ketorolac affected A-alpha/beta and A-delta fibers
❌ At clinically relevant concentrations, adding adjuvants to bupivacaine produced limited additional inhibition

💡 Why this matters:
These findings bridge a key gap between clinical practice and peripheral nerve physiology, clarifying how adjuvants may contribute to block characteristics.

✨ The takeaway:
PNB adjuvants can act directly on specific nerve fibers, but their clinical efficacy likely reflects a combination of direct and indirect mechanisms.

🔗 Read the full study: https://doi.org/10.1136/rapm-2025-106955