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Regional Anesthesia & Pain Medicine

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

04/03/2026

🚨 Suprascapular Nerve Blocks: Anatomy Matters—Down to the Fascicles

🧠 It is often believed that the target for a suprascapular nerve block in terms of landmarks and needle position—but a new article in RAPM highlights that the nerve’s microanatomy changes along its course, which may have real implications for technique selection and safety.

📊 Findings: The suprascapular nerve shifts from mostly monofascicular proximally (cervical segment) to increasingly multifascicular distally (supraspinous/infraspinous fossae), with important branching and tissue relationships.

💡 Takeaway: Where one targets the nerve may influence block performance and risk.

🔗 https://doi.org/10.1136/rapm-2026-107686

04/02/2026

🚨 Clear Solutions? Crystallization in Local Anesthetic Cocktails

🧪 New study in RAPM: common local anesthetic + adjuvant mixtures used in regional anesthesia can crystallize, raising safety concerns.

🔑 Key takeaways:
• Lidocaine mixtures: no crystals detected
• Mepivacaine/ropivacaine mixtures: crystals seen in most combos
• Worst combo: ropivacaine + bicarbonate
• Micropore filters (5 µm or 0.2 µm): reduced crystals, but often did not eliminate them, especially over time or with larger volumes

🔗 https://doi.org/10.1136/rapm-2026-107700

03/31/2026

🚨 Can Liposomal Bupivacaine Upgrade VATS Recovery?

🫁 In RAPM, a new RCT studying video-assisted thoracoscopic surgery (VATS) patients: liposomal bupivacaine vs bupivacaine + dexamethasone for thoracic paravertebral block (TPVB).

📊 Results: Liposomal bupivacaine extended analgesia ~56% (1160 vs 743 min) and improved early pain scores. Exploratory findings suggested less POD1 oxycodone, earlier ambulation/flatus, and higher satisfaction, with no difference in adverse events or length of stay.

💬 Would you use LB for longer-lasting TPVB in your VATS pathway?

🔗 https://doi.org/10.1136/rapm-2025-107478

03/30/2026

🚨 Does Anesthesia Shape Recurrence?

📚 This RAPM article highlights how anesthesia choice may influence cancer outcomes after resection for non-muscle invasive bladder cancer (NMIBC).

💉 In a randomized trial (Seoul National University Hospital, 2018–2020), patients who received spinal anesthesia had lower 2-year recurrence than those who received general anesthesia (~27% vs ~40%). Disease progression was also higher with general anesthesia (15.2% vs 7.8%), though not statistically significant.

💡 This article helps reshape perioperative decision-making — moving anesthesia planning from “how we get through the case” to “how we optimize long-term outcomes.”

🔗 https://doi.org/10.1136/rapm-2024-105949

03/29/2026

🎧 New RAPM Focus podcast: Rethinking pain after C-section

💡 Instead of focusing only on pain scores, the SPACE-Postpartum model looks at a cluster of symptoms that shape recovery: Sleep, Pain, Affect, Cognition, Energy. Early patterns may help identify who’s at risk for chronic pain or impaired recovery—and guide earlier support.

Should postpartum recovery be measured beyond pain scores?

🔗 https://rapmfocusbmj.podbean.com/e/episode-49space-postpartuma-multidomain-biopsychosocialframeworkfor-predictingchronic-pain-and-impairedrecoveryaftercesareandelivery-%e2%80%93proof-of/

03/27/2026

🧠 Conditioned Pain Modulation Made Simpler

Conditioned pain modulation (CPM) reflects endogenous pain inhibitory mechanisms and has potential as a clinical biomarker in pain medicine.

✨ Key points:

• TENS–pressure cuff paradigm offers a clinically feasible approach
• Higher inter-rater reliability compared to algometry
• Greater sensitivity to detect inhibitory CPM responses
• Comparable variability and inter-session reliability

🔍 Simplifying CPM assessment may facilitate its use in both clinical and research settings.

📖 Beltrá P et al.

👉 Read more in RAPM: https://doi.org/10.1136/rapm-2025-107402

$🫁 Diaphragm-sparing strategies in shoulder surgeryCombined infraclavicular + anterior suprascapular nerve blocks may off...$

03/24/2026

🫁 Diaphragm-sparing strategies in shoulder surgery

Combined infraclavicular + anterior suprascapular nerve blocks may offer an alternative to interscalene block (ISB) while preserving respiratory function.

✨ Key points:

• Equivalent postoperative analgesia vs ISB
• 0% incidence of hemidiaphragmatic paralysis
• Similar opioid consumption and patient satisfaction
• Potential option in patients with pulmonary risk

🔍 Could this combined approach redefine shoulder analgesia?

📖 Bravo D et al.

👉 Read the full article in RAPM: https://doi.org/10.1136/rapm-2026-107604

03/23/2026

🧠 Non-inferiority Study: Cooled vs Standard RFA for Lumbar Facet Pain

Radiofrequency ablation is an established technique to treat facetogenic low back pain by interrupting nociceptive input from medial branch nerves.

✨ Key points:
• Both cooled and standard techniques provide effective pain relief
• Significant improvements in function and quality of life
• High proportion of patients achieve ≥50% pain reduction
• Outcomes sustained up to 12 months

🔍 With appropriate patient selection and technique, both approaches show comparable effectiveness.

📖 Provenzano DA et al.

🔗 Discover more in RAPM: https://doi.org/10.1136/rapm-2025-107299

03/19/2026

🧠 Can a medical assistant-coached behavioral intervention improve chronic pain outcomes?

📈 This randomized controlled trial compared:
PRISM-CBT: resilience-enhanced CBT coached by medical assistants
Standard CBT vs Usual care

⚡️ Key findings:
✅ No difference in the primary outcome vs usual care at 8 weeks
✅ By 12 months, PRISM-CBT showed a 7.4-point greater improvement in FIQR global impact vs usual care
✅ PRISM-CBT produced the most consistent improvements in pain interference
✅ Compared with standard CBT, PRISM-CBT reduced pain interference at 8 weeks, 6 months, and 12 months
✅ Pain severity also favored PRISM-CBT at selected later time points

💡 Why this matters:
Behavioral therapies for chronic pain are effective but often hard to access. This study shows that medical assistants can deliver a manualized, digital, resilience-enhanced intervention with high fidelity, offering a practical, scalable model.

✨ The takeaway:
PRISM-CBT did not improve the primary endpoint at 8 weeks, but it showed promising long-term benefits, especially for pain interference, and may strengthen standard pain care in specialty clinics.

🔗 Read the full study:
https://doi.org/10.1136/rapm-2025-107389

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