Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2024
ReviewExtended reality navigation for pain procedures: a narrative review.
Extended reality (XR) technology, encompassing virtual reality, augmented reality, and mixed reality, has been widely studied for procedural navigation in surgical specialties. Similar to how ultrasound transformed regional anesthesia, XR has the potential to reshape how anesthesiologists and pain physicians perform procedures to relieve pain. ⋯ Early randomized controlled trials show potential for XR to improve procedural efficiency, but more comprehensive research is needed to determine if there are significant clinical benefits. Case reports demonstrate XR's utility in generating patient-specific navigation plans when difficult anatomy is encountered. Procedures that facilitate the generation and registration of XR images are most conducive to XR navigation, whereas those that rely on frequent re-imaging will continue to depend on traditional modes of navigation.
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Reg Anesth Pain Med · May 2024
ReviewEvaluating the balance of benefits and harms in chronic pain clinical trials: prioritizing individual participants over individual outcomes.
Randomized clinical trials (RCTs) generally assess efficacy and safety separately, with the conclusion of whether a treatment is beneficial based solely on the efficacy endpoint. However, assessing and combining efficacy and safety domains, using a single composite outcome measure, can provide a more comprehensive assessment of the overall effect of a treatment. Furthermore, composite outcomes can incorporate information regarding the relationship between the individual outcomes. In fact, such outcomes have been suggested in the clinical trials literature for at least 15 years. ⋯ Composite outcomes of benefits and harms are underutilized in chronic pain RCTs. The advantages and challenges of using such outcomes are discussed.
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Reg Anesth Pain Med · May 2024
ReviewAnalgesic benefits of regional anesthesia in the perioperative management of transition-related surgery: a systematic review.
Transition-related surgery is an effective treatment for gender dysphoria, but the perioperative analgesic management of transgender patients is nuanced and potentially complicated by higher rates of mood and substance use disorders. Regional anesthetic techniques are known to reduce pain severity and opioid requirements; however, little is known regarding the relative analgesic effectiveness of regional anesthesia for transgender patients undergoing transition-related surgery. ⋯ Despite the ever-growing demand for transition-related surgery, the relative analgesic effectiveness of regional anesthesia for transgender patients undergoing transition-related surgery is very understudied and insufficient to guide clinical practice. Our systematic review of the literature serves to underscore regional anesthesia for transition-related surgery as a priority area for future research.
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Reg Anesth Pain Med · Apr 2024
ReviewFascial plane approach to anesthetizing the radial, median, and ulnar nerves: an educational review.
Brachial plexus block provides effective anesthesia and analgesia for upper extremity surgery but requires injection of large anesthetic volumes near major vascular structures. Moreover, the extensive motor and sensory loss produced by plexus block often exceeds the neural distribution needed for corresponding surgical procedures. High-resolution ultrasound facilitates selective nerve blocks at nearly every level of the upper extremity. ⋯ Selective fascial plane injections can provide surgical anesthesia and postoperative analgesia in settings that might otherwise require much larger volumes of local anesthetic. These selective nerve blocks can match sensory loss with the anatomic pain distribution in each patient. Reliable techniques for selective nerve blocks of the upper extremity can expand the capabilities for ultrasound-guided regional anesthesia.