RAPM Focus

In this episode of RAPM Focus, Alopi Patel, MD, speaks with K. Elliott Higgins III, MD, and Courtney Burns, MD, about their powerful pain palette essay, “Beyond the block: a canvas for well-being and conversation in anesthesiology and pain medicine.” This essay accompanies Healing Emotional Wounds—a community-engaged art piece by medical and scientific illustrator Morgan Granzow.   Dr. Higgins is the director of health and well-being for UCLA's department of anesthesiology and perioperative medicine, a physician health officer for UCLA Health, and a practicing anesthesiologist with subspecialty expertise in regional anesthesia and acute pain medicine. His research focuses on measuring and understanding health care professional well-being through a systems lens. As founding leader of the Well-Being Influencers Survey for Healthcare (WISH) research consortium, he led the development of WISH, a validated tool designed to assess perceptions of organizational conditions that shape well-being rather than individual states like burnout. He also co-chairs the American Society of Anesthesiologists' well-being research working group and serves as both a member and change maker coach for the National Academy of Medicine's Action Collaborative on Clinician Well-Being and Resilience. Dr. Burns is an anesthesiology resident physician at Vanderbilt University Medical Center and member of the BH Robbins Scholars Physician-Scientist Development Program. Her research interests include clinician well-being among the anesthesiology workforce, psychological sequelae of adverse clinical events, and the association of clinician occupational well-being challenges with health care quality and patient outcomes. She is experienced in the medical humanities and has leveraged both visual art and narrative medicine in promoting well-being among students and clinicians. She also serves as a member of the American Society of Anesthesiologists' Committee on Physician Well-Being and the Society for Education in Anesthesia's Committee on Well-Being. Inviting reflection and dialogue within the RAPM community and beyond, this artwork isn't just visual—it's a conversation starter. By incorporating language that emerged from guided reflection, it aims to create safer, more compassionate clinical environments. Whether displayed in break rooms, pain clinics, or perioperative spaces, it offers clinicians a moment to pause, see themselves in others' words, and feel less alone. This discussion explores how this project seeks to destigmatize emotional struggles in medicine, promote well-being, and serve as a catalyst for further research—whether through focus groups, interviews, or broader institutional efforts. Most importantly, this piece reminds us that healing isn't just for our patients—it's for us, too. View more of Morgan Granzow's medical and scientific illustrations here. 

In this episode of RAPM Focus, executive editor Steven Cohen, MD, discusses the September 2024 publication of “Current state of the pain medicine match: perspective and an eye to the future,” with Meredith Barad, MD, Anuj Aggarwal, MD, and Lynn Kohan, MD. This letter explores the rationale behind reassessing the NRMP's utility for pain medicine, examining historical and current trends, and considering the implications of withdrawing from the match. Despite a recent decline in applicants and an increase in unfilled positions, the APPD advocates for continued participation in the match. The match ensures equitable and stable recruitment, preventing the chaotic pre-match environment of competitive, early offers. Data from similar specialties highlight the pitfalls of non-match systems, such as increased applicant pressure and reduced program visibility. The APPD supports maintaining the NRMP match while implementing reforms like preference signaling to address evolving challenges. The APPD aims to preserve the match's benefits and ensure a stable future for pain medicine fellowship recruitment. Dr. Barad is a clinical associate professor in anesthesiology (pain) and neurology at Stanford. She is the co-director of the Stanford Facial Pain Program and focuses on headache and facial pain. She completed her undergraduate work at the University of Texas at Austin and graduated from Stanford University Medical School in 2003. After her internship at Santa Clara Valley Medical Center in San Jose, CA, she went on to a neurology residency and pain fellowship at Stanford. She is board certified in neurology, headache, and pain. She is the associate division chief of education and program director for the pain fellowship. She is the current president of the American Pain Program Directors. She serves as the chair of the headache and facial pain special interest group for the American Academy of Pain Medicine and is on the editorial board of Pain Medicine. Dr. Aggarwal is a clinical assistant professor of anesthesiology and the associate program director of the pain medicine fellowship at Stanford University, where he specializes in headache and orofacial pain. In addition to his work in pain medicine, he helps lead the teaching of medical students serving as director of pharmacology and as associate director for the Science of Medicine.  Dr. Kohan is a professor of anesthesiology and pain medicine at the University of Virginia. She is the division chief and the chronic pain program director. She serves on the board of directors for national pain societies including ASRA Pain Medicine. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on X @RAPMOnline, LinkedIn @Regional Anesthesia & Pain Medicine, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

This AI-generated episode of RAPM Focus discusses the May 2024 publication of “Single-bolus Injection of Local Anesthetic, With or Without Continuous Infusion, for Interscalene Brachial Plexus Block in the Setting of Multimodal Analgesia: A Randomized Controlled Unblinded Trial” by Dr. Patrick Rhyner et al.” For anyone facing shoulder surgery, pain management after the procedure is crucial. In this paper, Rhyner et al. question whether or not a continuous infusion of pain medication through a catheter is better than giving a patient a single injection after having shoulder surgery. The paper discusses a multimodal approach of pain management—dethamexazone, magnesium, acetaminophen, and ketorolac. In this study, patients undergoing two common shoulder surgeries—shoulder arthroplasty or arthroscopic rotator cuff repair—were divided into two groups, in which one group received a continuous infusion of medication via catheters, or a single dose of pain relief. Results were measured by how much morphine patients needed through a patient-controlled analgesia pump during the first 24 hours after surgery. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on X @RAPMOnline, LinkedIn @ Regional Anesthesia & Pain Medicine, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

Hosted by RAPM Editor Eric Schwenk, MD, this episode of RAPM Focus welcomes RAPM Associate Editor Mark Bicket, MD, PhD, and medical student Sama Ramo following the recent publication of their original research paper, “Risk Factors for Persistent Postoperative Opioid Use: An Entity Distinct from Chronic Postsurgical Pain,” included in the February 2025 special edition of RAPM, titled “Tackling the Challenge of Chronic Postsurgical Pain.” Persistent postoperative opioid use results when patients continue to take prescription opioids well beyond the time their pain after surgery would be expected to resolve. In some cases, this is a couple days; in other cases, this is several weeks. There are many challenges associated with prescription opioid use, including the lack of a truly safe dose, so there is risk across the continuum. Patients facing persistent postoperative opioid use potentially confront worse outcomes, higher rates of health care utilization, and higher rates of mortality compared to patients not enduring persistent postoperative opioid use. Dr. Mark Bicket is an associate professor of anesthesiology with tenure at the University of Michigan and a joint appointment in the Department of Health Management and Policy at the School of Public Health. Additionally, he is co-director of the Overdose Prevention Engagement Network (OPEN). A clinician-scientist and practicing physician anesthesiologist, Dr. Bicket has pioneered evidence-based approaches to reduce opioid-related harms and improve the treatment of persons who experience pain. He currently leads an NIH R01 study examining pain-related outcomes for persons with opioid use disorder who have surgery and serves as PI for two pragmatic trials funded by the Patient-Centered Outcomes Research Institute including the CARES study, an international randomized clinical trial examining commonly prescribed treatments for postoperative pain. He previously served on the National Academy of Medicine ad hoc committee on evidence for opioid prescribing guidelines in 2018-2019 and a workshop on opioid disposal in 2023. Dr. Bicket has advised the White House, FDA, CMS, state governments, and national organizations on pain and opioid issues. His research, which includes 120 peer-reviewed articles, has appeared in JAMA, NEJM, and BMJ, and has been supported by the Foundation for Anesthesia Education and Research (FAER), SAMHSA, and CDC. Sama Ramo is a second-year medical student at Oakland University William Beaumont School of Medicine. She is a Foundation for Anesthesia Education and Research scholar. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on X @RAPMOnline, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

This episode of RAPM Focus introduces something new—an episode generated completely by artificial intelligence, specifically Google Notebook. As part of RAPM's commitment to exploring innovative ways to deliver content, RAPM is trialing this approach and would love to hear your feedback. This AI-generated episode is centered around an original research paper first published in RAPM in November 2024, “Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of upper and lower limb nerve blocks.” This podcast episode highlights the power of clear communication in medicine, and the ways in which nomenclature brings order to the world of medical terminology. Specifically, the inconsistent naming of nerve blocks can lead to confusion and chaos that result in real consequences. Different doctors and researchers using different names for the same techniques leads to difficulties in comparing results and sharing knowledge. “Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of upper and lower limb nerve blocks” dives into how convoluted the names of nerve blocks have become. This leads to a recipe for miscommunication—not ideal in the world of pain management. By standardizing the nomenclature of nerve blocks, patient safety is increased for those undergoing surgeries involving nerve blocks. The study lays out a clear system for naming nerve blocks in order to standardize the language of nerve blocks. This system showcases the importance of nomenclature in not just nerve blocks, but in pain management and medicine as a whole. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a health care practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Find RAPM on X @RAPMOnline, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

In this episode of RAPM Focus, Editor-in-Chief Brian Sites, MD, is thrilled to welcome Kesavan Sadacharam, MD, and Allison Fernandez, MD, following the April 2024 publication of their original research paper, “Multisite prospective study of perioperative pain management practices for anterior cruciate ligament reconstruction in adolescents: Society for Pediatric Anesthesia Improvement Network (SPAIN) Project Report.” Unwarranted variation in health care refers to differences in health care delivery that cannot be attributed to patient illness, medical evidence, or patient preferences. Instead, these variations arise from differing local medical practices, resource availability, and physician decision-making processes. Unwarranted variations can lead to sub-optimal patient outcomes, with some patients receiving unnecessary or harmful treatments while others may not receive beneficial interventions. Two individuals are behind a multi-center collaborative initiative that looks at the utilization of regional anesthesia and pain medicine techniques for ACL reconstruction. Dr. Allison Fernandez is an associate professor at Johns Hopkins All Children's Hospital, practicing pediatric anesthesia, and pediatric acute and chronic pain management. Dr. Fernandez started a video series, Women of Impact in Anesthesia, empowering women in medicine. Dr. Kesavan Sadacharam is a pediatric anesthesiologist and associate professor at Nemours Children's Health, located in Wilmington, DE. He is currently the director of regional anesthesia and practices both acute and chronic pain management. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on X @RAPMOnline, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

In this episode of RAPM Focus, Editor-in-Chief Brian Sites, MD, is thrilled to welcome Laura Graham, PhD, MPH, and Sesh Mudumbai, MD, MS, following the April 2024 publication of their brief technical report, “Use of natural language processing method to identify regional anesthesia from clinical notes.” One definition of medicine is the science and practice of the diagnosis treatment in prevention of disease. Science itself involves diagnoses and relies on the process of assessing data to determine cause and effect in therapies. However, in the busy world of clinical productivity and limited resources, the science of medicine is often overlooked. Physicians struggle to extract meaningful data from electronic medical records, despite their great potential. This is often due to the prioritization of funding for billing and compliance, which leads to challenges in accessing meaningful data. Additionally, barriers such as data license agreements and institutional review board considerations further complicate matters. This is why Dr. Sites is excited about new technologies, such as artificial intelligence that can assist physicians in the practice in the science of medicine. Dr. Laura Graham is an epidemiologist with VA's Health Economics Resource Center at the VA Palo Alto Health Care System and an associate faculty with the Stanford-Surgery, Policy, Improvement Research, and Education Center at the Stanford University School of Medicine. Her research interests include causal inference methods and improving clinical processes of care for surgery. Dr. Sesh Mudumbai is an associate professor in the Department of Anesthesiology, Perioperative, and Pain Medicine at Stanford University School of Medicine and a staff anesthesiologist at the VA Palo Alto Health Care System. His research interests include using and developing informatics tools to improve opioid management and perioperative outcomes. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on X @RAPMOnline, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

In this special episode, RAPM Focus takes a break from its usual format of discussing specific research projects to discuss instead how research in health care is increasingly vital yet often hindered by escalating costs and time constraints. Editor-in-Chief Brian Sites, MD, discusses these challenges with Alexander (Xan) Abess, MD, and Jonathan Weed, MD. Traditional, large scale, randomized controlled trials are resource intensive, making them challenging for clinicians to conduct. As a result, innovative approaches to engage in knowledge acquisition are becoming paramount. Creating a scholastic environment within the anesthesia department not only fosters a culture of continuous learning, but also becomes essential for attracting and retaining talent. Dr. Abess is an anesthesiologist at Dartmouth Hitchcock Medical Center and assistant professor of anesthesiology and perioperative medicine at Geisel School of Medicine at Dartmouth. He has previously served as the vice chair of quality and safety, department of anesthesiology and perioperative medicine, and is actively involved with the Multi-Center Perioperative Outcomes Group (MPOG). He is the founder and Director of IDEA Lab (Innovation, Development, and Entrepreneurship in Anesthesiology). Xan has a wide range of clinical experience (private practice, academic medicine, military medicine) and medical device development experience, having previously started his own medical device company. He understands well the challenges of medical innovation and truly enjoys helping others achieve their development goals while also attempting to improve the quality of health care delivery and simultaneously addressing our broader economic and workforce challenges. Dr. Weed is a clinical assistant professor of anesthesiology at Dartmouth Hitchcock Medical Center. He is a graduate of Tulane Medical School and completed his anesthesiology residency at Beth Israel Deaconess Medical Center, followed by a fellowship at Dartmouth Hitchcock Medical Center in regional anesthesia. He spent several years as a residency program director at Tulane Medical Center before returning to Tulane Medical Center in 2021. His most recent interests relate to the use of the electronic health record to improve clinical workflow in research within the department. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a health care practitioner's judgment, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on X @RAPMOnline, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

In this episode of RAPM Focus, Editor-in-Chief Brian Sites, MD, is delighted to be joined by Alexander Stone, MD, and Kamen Vlassakov, MD, following the April 2024 publication of their original research paper, “Anesthesia Start Time Documentation Accuracy where Peripheral Nerve Block is the Primary Anesthetic.” Understanding the intricacies of billing is crucial for anesthesiologists in all practice settings, not just in private practice. Proper billing practices not only ensure fair compensation for services rendered, but also impact patient care, hospital finances, and overall health care delivery. Anesthesiologists who engage with billing gain a better understanding of health care economics, which is essential for navigating the complex landscape of modern health care. Dr. Stone is a regional anesthesiologist at Brigham and Women's Hospital. He is an assistant professor of anesthesia at Harvard Medical School and Associate Editor of RAPM. Dr. Vlassakov is the chief of the division of regional and orthopedic anesthesiology, as well as the program director of the regional anesthesiology and acute pain medicine fellowship at Brigham and Women's Hospital. He is an associate professor of anesthesia at Harvard Medical School and also an Associate Editor of RAPM. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on X @RAPMOnline, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

In this episode of RAPM Focus, Editor-in-Chief Brian Sites, MD, is delighted to be joined by Ryan D'Souza, MD, and Nasir Hussain, MD, following the February 2024 publication of their review, “Methodological and Statistical Characteristics of Meta-Analyses on Spinal Cord Stimulation for Chronic Pain: A Systematic Review.” Both of these anesthesiologists are prolific in their research and contributions to the regional anesthesia and pain medicine community. Best practice advisories and policies tend to stem from the results of systematic reviews and metanalysis, thus the stakes are very high for a journal to ensure that the results are meaningful and valid. The mathematical principles and assumptions of systematic reviews and meta-analyses are quite complex, which often exceeds the capacity of many journals to truly adjudicate. To further complicate matters, there are emerging techniques that include network meta-analyses that take even more expertise to review. Therefore, better understanding content areas where there are strengths and weaknesses around systematic reviews is critical to best informing clinical practice. Dr. D'Souza is a pain medicine physician and anesthesiologist at the Mayo Clinic. He is an associate professor, director of neuromodulation, and director of the in-patient pain service. He is an associate editor and social media editor for RAPM. Dr. Hussain is a pain medicine physician and anesthesiologist at the Ohio State University Wexner Medical Center. He is an assistant professor, associate program director for anesthesiology residency, and assistant program director of the chronic pain fellowship. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on X @RAPMOnline, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

In RAPM Focus's latest podcast series, Article Reads, Alopi Patel, MD, narrates “Artificial intelligence and regional anesthesiology education curriculum development: navigating the digital noise” by Kristopher M Schroeder and Nabil Elkassabany. Originally published in Regional Anesthesia & Pain Medicine in June 2024, this daring discourse is now available in podcast format for an all new RAPM experience. Artificial intelligence (AI) has demonstrated a disruptive ability to enhance and transform clinical medicine. While the dexterous nature of anesthesiology work offers some protections from AI clinical assimilation, this technology will ultimately impact the practice and augment the ability to provide an enhanced level of safe and data-driven care. An essential mission of academia is education, and challenges are frequently encountered when working to develop and implement comprehensive and effectively targeted curriculum appropriate for the diverse set of learners assigned to teaching faculty. Large language models offer the promise of targeted curriculum and content development that can be individualized to a variety of learners at various stages of training.  https://pubmed.ncbi.nlm.nih.gov/38876802

In this episode of RAPM Focus, Editor-in-Chief Brian Sites, MD, sits down with Michael Barrington, MD, to discuss best practice advisories and policies with systematic reviews. Best practice advisories and policies tend to stem from the results of systematic reviews and metanalysis, thus the stakes are very high for a journal to ensure that the results are meaningful and valid. As part of a RAPM initiative to establish education and standards for researchers interested in submitting a systematic review or meta-analysis we participate in a joint publication with the journal, Anesthesia and Analgesia.  Dr. Barrington is well known in the regional anesthesia community as he is currently the section editor for Regional Anesthesia for the journal, Anesthesia and Analgesia. He has had a recent appointment as professor of anesthesiology at OHSU and is transitioning to the University of Washington.  Some topics covered by Dr. Sites and Dr. Barrington in this podcast are:  How having a broad team with a broad scope of expertise as part of the authorship team reflects some of the important components of a systematic review. How many review authors are unable to articulate a clear rationale for performing the reviews which often is associated with a lack of a very a clear research question. The basic resources and expertise needed to perform a systematic review at a high level. What protocol is in a systematic review and why it is an important first step. PICO (Participant/ Population, Intervention, Compareta, Outcomes). *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on X @RAPMOnline, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

In this episode of RAPM Focus, Associate Editor Ed Mariano, MD, MAS, FASA substitutes for Editor-in-Chief Brian Sites, MD, to discuss the diverse publishing landscapes in the scientific field with Executive Editor Ruth Landau, MD. Dr. Mariano is a professor at Stanford University School of Medicine. Dr. Landau is the Virginia Apgar professor and the Chief of Obstetric Anesthesiology at Columbia University. She is also the director of the Center of Precision Medicine within the department and a past president for the Society for Obstetric Anesthesia and Perinatology (SOAP). Dr. Launda is known globally for her expertise and leadership with Obstetric Anesthesia, Labor Analgesia, and Maternal Health and Outcomes. In addition to her extensive work with Obstetrics, she also serves on the RAPM editorial board.  Dr. Mariano and Dr. Landau discuss the publishing approach RAPM has taken. RAPM is dedicated to publishing research that has the potential to have a real clinical impact and better-informed decision making. There is a huge responsibility in publishing to inform clinicians, to give back to researchers, and selecting the right reviewers.  *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on X @RAPMOnline, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

In this episode of RAPM Focus, Dr. Brian Sites is delighted to support the work of Dr. Ottokar Stundner, MD, and colleagues by discussing the use of liposomal bupivacaine trends following the March 2024 publication of “Crystallization of mixtures of local anesthetics with and without select adjuvants: a semiquantitative light microscopy analysis.” Dr. Studener completed his anesthesia residency in Salzburg, Austria, as well as a research fellowship in regional anesthesia and perioperative outcomes at the Hospital for Special Surgery in New York. After his training, he joined the faculty at Innsbruck Medical University, also in Austria, where he currently is co -chair of pediatric anesthesia. He holds an MBA in Master of Public Health degrees. from the Imperial College of London and is an editorial fellow at the BJA. With its high expense and questionable benefit over conventional forms of local analgesia, it is possible that the use of liposomal bupivacaine is declining—especially in the United States. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on X @RAPMOnline, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

In this episode of RAPM Focus, Dr. Brian Sites discusses the perioperative use of hallucinogens with Trent Emerick, MD, MBA, following the February 2023 publication of Dr. Emerick's paper, “Perioperative considerations for patients exposed to hallucinogens.” Dr. Trent Emerick is currently an associate professor in the departments of anesthesiology and perioperative medicine and bioengineering at the University of Pittsburgh Medical Center and School of Medicine. He was a fellowship director for the chronic pain fellowship, and associate chief in the medical director of the UPMC chronic pain division. He is also the designated pain specialist for the NLF Pittsburgh Steelers. Medicine is always changing, providing a career steeped in creativity. Hallucinogen use in the general population is growing, becoming more and more common. There is a renewed interest in the therapeutic benefits of drugs commonly classified as hallucinogens. These drugs are complicated and alter the sensorium. Psychedelics, a type of hallucinogen, are mediated by serotonin to a receptor and can help to soothe pain. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on Twitter @RAPMOnline.

In this episode of RAPM Focus, Dr. Brian Sites sits down with Daryl Henshaw, MD, and Christopher Edwards, MD, to discuss “Evaluating residual anti-Xa levels following discontinuation of treatment-dose enoxaparin in patients presenting for elective surgery: a prospective observational trial,” first published in June 2023. Dr. Daryl Henshaw completed his medical school residency in regional anesthesia and acute pain fellowship training at Wake Forest. He is the associate vice chair of clinical operations at Atrium Health Wake Forest Baptist, the section head of regional anesthesia and acute pain management, and the medical director of acute pain services. Dr. Christopher Edwards is a graduate of Louisiana State University Health Sciences at Wake Forest for both anesthesia and fellowship training in RAPM. He is the medical director for regional anesthesia and acute pain. Dr. Henshaw and colleagues performed a prospective observational trial, where they asked the question if current guidelines to hold full anti-coagulation dose of Lovenox for 24 hours before surgery resulted in adequate anti-Xa level activity to support the performance of neuraxial or deep anesthetic type nerve block procedures. Consenting patients on treatment-dose enoxaparin were randomized to either a 24-hour group (last dose at 07:00 the day prior to surgery) or a 36-hour group (last dose at 19:00 2 days prior to surgery). On arrival for surgery, blood samples were obtained to assess residual anti-Xa level activity and renal function. The primary outcome was residual anti-Xa level activity following the last treatment dose of enoxaparin. Incorporating all patients, linear regression modeling was performed to predict the timepoint at which the level of anti-Xa activity reliably fell below 0.2 IU/mL. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on Twitter @RAPMOnline.

In this podcast episode, RAPM Editor-In-Chief Brian D. Sites discusses the massive growth opportunities in the exciting future of pain medicine. Sites highlights the importance that “anesthesiologists help define the value of medical interventions that we offer for pain management.” As RAPM begins to receive more submissions relating to costs, Dr. Sites stresses how critical it is to understand how costs are factored into the interventions offered in health care, as costs can be prohibited. Dr. Sites hopes we may start to connect the dots to larger outcomes like the chronification of pain, mortality, major morbidity, extended length of stay, and more, as the interventions we offer can positively impact these outcome metrics. Watch the full podcast episode for more information. For more on the World Day of Pain initiative, please see: https://esraeurope.org/meeting/1st-world-day-of-regional-anesthesia-pain-medicine/.

Data describing the relationship between specific traumatic injuries and opioid use is lacking, which is why RAPM is so delighted to support the work of Matthew Mauck, MD, PhD, and colleagues. In this episode of RAPM Focus, RAPM Editor-in-Chief Brian Sites, MD, discusses “Incidence of persistent opioid use following traumatic injury with Dr. Mauck, first published in June 2023. Dr. Mauck is an assistant professor and vice chair of research for the University of North Carolina's department of anesthesiology. He is a practicing pain physician, and his main research focus is on preventing the transition of acute to chronic pain following traumatic injury. Upon individuals hospitalized after surgery, up to 60% continue to experience chronic pain at 12 months. Dr. Mauck and colleagues used insurance claims data from over a 20-year period to estimate the incidents of new persistent opioid use in three hospitalized trauma populations. Burn injury, motor vehicle collision, and orthopedic injury. New persistent opioid use is defined as the receipt of greater than one opioid prescription 90-180 days following injury in an individual with no opioid prescriptions during the year prior. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on Twitter @RAPMOnline. #opioidprescription #opioiduse #persistentopioiduse #traumaticinjury #regionalanesthesia #acutepain #chronicpain #anesthesia #pain #painmanagement #MedEd #medicine

RAPM Editor-in-Chief Brian Sites, MD, joins Hsiangkuo Yua, MD, PhD, and Aniket Natekar, MD, two coauthors of “Real-world study of intranasal ketamine for use in patients with refractory chronic migraine,” first published in May 2023. Dr. Hsiangkuo Yuan received his medical degree from National Yang-Ming University in Taipei, Taiwan, and a PhD in biomedical engineering at Duke University. He joined Jefferson Headache Center in 2014 as a research fellow, then completed a neurology residency and headache fellowship at Thomas Jefferson University. Dr. Yuan is currently an associate professor of neurology and the director of clinical research at the Jefferson Headache Center. He is also the vice chair of ASRA Headache SIG and an associate editor of RAPM. His research interests include real world analysis of novel migraine therapeutics and a fundamental understanding of CSF dynamics in patients with CSF high and low pressure headaches. Dr. Aniket Natekar pursued his medical education at the John A. Burns School of Medicine at the University of Hawaii in Honolulu. He attended Thomas Jefferson University Hospital in Philadelphia, where he completed his residency in general neurology, and then a fellowship in headache medicine at the Jefferson Headache Center. Dr. Natekar is currently a practicing neurologist with a subspecialty training in headache management. Migraine is a common and disabling headache disorder with huge societal implications in terms of human suffering and loss of productivity. The World Health Organization recognizes its importance by ranking it in seventh place among worldwide diseases causing disability. Refractory chronic migraine headache is a subset condition of migraines. As the name suggests, it is an extremely unfortunate situation with limited treatment options. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on Twitter @RAPMOnline. #headache #headachedisorder #migraine #refractorychronicmigraine #respiratorycomplications #intranasalketamine #regionalanesthesia #chronicpain #anesthesia #pain #painmanagement #MedEd #medicine

RAPM Editor-in-Chief Brian Sites, MD, joins Lei Xu, MD, and Ed Mariano, MD, MAS, FASA, FASRA, two coauthors of “Rate of occurrence of respiratory complications in patients who undergo shoulder arthroplasty with a continuous interscalene brachial plexus block and associated risk factors,” first published in May 2023. Dr. Xu is a clinical assistant professor in the department of anesthesiology at Stanford. She received her medical degree from Stanford before completing her residency in anesthesiology at the University of California San Francisco, and then a fellowship in regional anesthesia and acute pain medicine at Stanford. She is interested in the application of regional anesthesia outside the operating room. Her research interests include studying the functional outcomes of clinical pathways that include regional anesthesia in the primary arthroplasty in acute trauma populations. Dr. Mariano is a professor and senior vice chair in the department of anesthesiology at Stanford. He has developed techniques and patient care pathways to improve post-operative pain, patient safety, and other outcomes, and has published over 250 peer-reviewed articles. He has held leadership positions in the California Society of Anesthesiologists, American Society of Anesthesiologists, American Society of Regional Anesthesia and Pain Medicine, and multiple journal editorial boards. In their retrospective observational study, over 1,000 patients were evaluated undergoing total shoulder replacement with a continuous interscalene block. Respiratory complications were categorized into four groups: none, mild, moderate, and severe. Interscalene blocks are important to the success of these surgeries, but there remain concerns about respiratory morbidity. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on Twitter @RAPMOnline. #interscalenebrachialplexusblock #interscaleneblock #respiratorymorbidity #respiratorycomplications #arthoplasty #shoulderarthoplasty #localanesthetic #regionalanesthesia #chronicpain #anesthesia #pain #painmanagement #MedEd #medicine

RAPM Editor-in-Chief Brian Sites, MD, joins Daniela Bravo, MD, and Julián Aliste, MD, two co-authors of “Randomized clinical trial comparing pericapsular nerve group (PENG) block and periarticular local anesthetic infiltration for total hip artholasty,” first published in February 2023. In this episode, they discuss the explosion of fascia PENG blocks in the past decade. Dr. Bravo is an assistant professor in the department of anesthesiology and perioperative medicine at the University of Chile. She is the co-director of the regional anesthesia and acute pain service. Dr. Julien Alaste is an associate professor at department of anesthesiology and perioperative medicine at the University of Chile. He is the director of the regional anesthesia and acute pain fellowship. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on Twitter @RAPMOnline. #PENGblock #arthoplasty #localanesthetic #regionalanesthesia #chronicpain #anesthesia #pain #painmanagement #MedEd #medicine

RAPM Editor-in-Chief Brian Sites, MD, joins Mercy A Udoji, MD, CMQ, FASA and Sudheer Potru, DO, FASA, FASAM, two coauthors of “Violence in the pain clinic: the hidden pandemic,” first published in August 2023 rapm-august 2023.pdf. Dr. Udoji is an associate professor of anesthesiology and pain medicine at Emory University School of Medicine.  Dr. Potru is a triple-board-certified anesthesiologist, interventional pain physician, and addiction medicine specialist with strong interest in both opioid safety and addiction. 

RAPM Editor-in-Chief Brian Sites, MD, joins Anjali A. Dixi, MD, the senior author of “Hospital-level variability in regional nerve block administration by race for total knee arthroplasty,” first published in December 2022 (https://rapm.bmj.com/content/early/2022/12/13/rapm-2022-104028). Dr. Dixi is from the Stanford University School of Medicine, in Stanford, CA.

The political, professional, and cultural implications of using cannabinoids remain controversial despite its increased prevalence over the last 20 years. The American Society of Regional Anesthesia and Pain Medicine established a working group in November 2020 to review the evidence and knowledge gaps around cannabis use in the perioperative period and develop clinical recommendations for the management of patients using cannabis in this setting.   Authors Shalini Shah, MD, MBA, and Hance Clarke, MD, FRCPC, PhD, joined RAPM Editor-in-Chief Brian Sites, MD, to discuss committee's findings, which were published in the article “ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids” in January 2023 (https://rapm.bmj.com/content/48/3/97).   The committee used a Delphi method with > 75% consensus to answer nine clinical questions. The members concluded that all surgical patients should be screened for cannabinoid use prior to surgery, heavy users be counseled on the negative effects on postoperative pain control, and surgery be postponed for patients who present with acute cannabis intoxication. They also advised that pregnant patients be educated on the risks of maternal cannabis on the fetus/neonate.   Dr. Shalini Shah is a professor and vice chair for the department of anesthesiology and director of perioperative services at the University of California at Irvine School of Medicine. She completed her residency in anesthesiology from Cornell University and a combined fellowship in adult and pediatric chronic pain at Harvard Medical School. She is the founder of the Pediatric Pain Program at UC Irvine and has previously served as associate program director for the pain medicine fellowship. Dr. Shah is the recipient of the ASRA Pain Medicine Chronic Pain Research Grant Award in 2017 for her landmark work in onabotulinumtoxinA (BOTOX®) use in pediatric migraine pain.   Dr. Hance Clarke is the director of pain services and the pain research unit at the Toronto General Hospital in Toronto, Canada. He is the knowledge translation chair for the University of Toronto Centre for the Study of Pain and an associate professor in the department of anesthesiology and pain medicine at the University of Toronto. Dr. Clarke has authored more than 150 peer-reviewed publications and has been invited to speak on pain control, cannabis, and the opioid crisis to the House of Commons in Ottawa, Canada, and elsewhere around the world.   *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others.   Podcast and music produced by Dan Langa. Find us on Twitter @RAPMOnline.

The impact of the COVID-19 pandemic was especially challenging for vulnerable populations, such as those with chronic long-term health conditions, mental health conditions, and substance use disorders. Lockdowns and fear of spread led to barriers for patients whether they were accessing methadone through opioid treatment programs or being prescribed buprenorphine. A systematic review first published online in October 2022 sought to identify whether there was a change in opioid use and misuse outcomes during the COVID-19 pandemic. Authors Siddartha Simha, MD, and Mark C. Bicket, MD, PhD, joined RAPM Editor-in-Chief Brian Sites, MD, to discuss their article, “Impact of the COVID-19 pandemic on opioid overdose and other adverse events in the USA and Canada: a systematic review,” published October 2022 (https://rapm.bmj.com/content/48/1/37). The authors found that opioid-related emergency medicine use increased in most studies for both service calls and emergency department visits. Urine drug testing positivity results increased in all studies for fentanyl, and in most studies for heroin and oxycodone. Naloxone dispensation was unchanged and decreased in one study. The authors concluded that efforts to curb the spread of COVID-19 aligned with an increase in the opioid crisis severity, which has implications for future pandemic responses. Dr. Siddartha Simha is a third-year anesthesiology resident at Michigan Medicine in Ann Arbor. Originally from Troy, MI, he obtained his medical degree from Oakland University William Beaumont School of Medicine in Auburn Hills, MI. Dr. Simha has a strong interest in acute and chronic pain management and research with plans to pursue a clinical fellowship in pain medicine. Dr. Mark C. Bicket is the co-director of the Opioid Prescribing Engagement Network and an assistant professor at the University of Michigan Medical School with a joint appointment in the School of Public Health. A clinician scientist and practicing physician, his work has been supported by the National Institutes of Health, the Substance Abuse and Mental Health Services Administration, the Foundation for Anesthesia Education and Research, and the Patient-Centered Outcomes Research Institute. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on Twitter @RAPMOnline.

In November of 2021, the Regional versus General Anesthesia for Promoting Independence after Hip Fracture (REGAIN) trial was published in the New England Journal of Medicine. This study was a pragmatic randomized superiority trial to evaluate spinal anesthesia as compared with general anesthesia in 1,600 patients. The authors concluded that “spinal anesthesia for hip fracture surgery in older adults was not superior to general anesthesia with respect to survival and recovery of ambulation at 60 days.” In this month's RAPM Focus, Editor-in-Chief Brian Sites, MD, covers both angles of this story in a daring discourse with Alexander Stone, MD, lead author of “There remains a role for neuraxial anesthesia for hip fracture surgery in the post-REGAIN era,” published March 2023 (https://rapm.bmj.com/content/early/2023/03/27/rapm-2022-104071), and Eric Schwenk, MD, lead author of “General anesthesia is an acceptable choice for hip fracture surgery,” also published March 2023 (https://rapm.bmj.com/content/early/2023/03/27/rapm-2023-104454). Dr. Alexander Stone is an anesthesiologist at Brigham and Women's Hospital, and an assistant professor at Harvard Medical School. He completed his medical school at Johns Hopkins and his residency training at Brigham and Women's. He went on to complete a regional anesthesia and acute pain fellowship at Hospital for Special Surgery, before returning to Brigham as a faculty member. His research interests include expanding access to regional anesthesia through enhanced recovery program implementation, as well as collaborating with other specialties. Dr. Eric Schwenk completed a fellowship in regional anesthesia and acute pain at Thomas Jefferson University Hospital in 2013 and has remained on staff as a faculty member. His research interests center on ketamine for migraine, perioperative ketamine, outcomes after orthopedic surgery, and challenging long-held dogmas in medicine. He has been an active speaker for ASRA Pain Medicine, is on the Regional Anesthesia & Pain Medicine editorial board, and is a co-author of the REGAIN study. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on Twitter @RAPMOnline.

Proponents of fascial plane blocks argue that their value can be found in opioid reduction and improvement of pain scores. On the other hand, critics argue that the effect size tends to be very small, amounting to a placebo. To address these conflicting ideas, a recent study examined the role of quadratus blocks and analgesia for laparoscopic hemicolectomy. In this month's RAPM Focus, Editor-in-Chief Brian Sites, MD, joins Jens Borglum, MD, PhD, the senior author of “Anterior quadratus lumborum block does not reduce postoperative opioid consumption following laparoscopic hemicolectomy: a randomized, double-blind, controlled trial in an ERAS setting,” first published in September 2022 (https://rapm.bmj.com/content/48/1/7). This fascinating study had 69 patients randomized to receive either an anterior quadratus lumborum block or isotonic saline, a placebo. Dr. Jens Borglum is a consultant anesthetist, clinical research associate professor, and head of research at Zealand University Hospital, University of Copenhagen, Denmark. His main interests are ultrasound-guided nerve blocks and he is a prolific researcher and contributor to Regional Anesthesia & Pain Medicine. His clinical and research insights during the peer-review process are invaluable. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on Twitter @RAPMOnline.

Guidelines hold great importance in pain medicine. With many interventional procedures, there is some evidence for efficacy, but wide variation in study results due to differences in technique, interpretation, and implementation. In this month's RAPM Focus, Executive Editor Chad Brummett, MD, joins Steven Cohen, MD, the senior author of “Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group,” first published in November 2021 (https://rapm.bmj.com/content/47/1/3). These guidelines are a valuable resource for trainees, fellows, and anyone who works with them. Dr. Steven Cohen is a professor of anesthesiology and critical care medicine, neurology, physical medicine and rehabilitation, and psychiatry and behavioral sciences at the Johns Hopkins School of Medicine and Uniformed Services University of the Health Sciences in Baltimore, MD. He is also chief of pain medicine and director of pain operations at Johns Hopkins and director of pain research at Walter Reed National Military Medical Center. He has published over 400 peer-reviewed articles and book chapters in journals such as Lancet, JAMA, BMJ, Canadian Medical Association Journal, Anesthesiology, Pain, and The New England Journal of Medicine. In addition to his academic work, Dr. Cohen is a retired colonel in the United States Army. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on Twitter @RAPMOnline.

For interventional procedures that involve implanting devices or ablating tissues, it is common for patients to undergo prognostic tests to determine if they are responders prior to moving on to permanent procedures. However, definitions of responders and the number of prognostic tests necessary has caused some confusion. In this month's RAPM Focus, Editor-in-Chief Brian Sites, MD, joins David Provenzano, MD, and Jozef Leech, to discuss their study “Evaluation of lumbar medial branch blocks: how does the second block influence progression to radiofrequency ablation?,” first published in July 2022 (https://rapm.bmj.com/content/47/12/719). In a single-center retrospective review, 224 patients with two consecutive local anesthetic-only blocks were examined for pain relief. Dr. David Provenzano is president-elect of the American Society of Regional Anesthesia and Pain Medicine. He is currently an adjunct associate professor at the University of Pittsburgh, is on the executive committee of the Western PA Surgery Center, and is a critical member of the editorial board at Regional Anesthesia & Pain Medicine. Jozef Leech is a native of Johnstown, PA, and graduated from Washington & Jefferson College in 2020 with his Bachelor of Arts in biology. He completed 2 years of internship work with Dr. Provenzano at Pain Diagnostics and Interventional Care located in Pennsylvania. In August of 2022, Jozef started Kent State University College of Podiatric Medicine in Independence, OH. He is an active member with the American College of Foot and Ankle Surgeons. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others.

The International Association for the Study of Pain defines pain as: “An unpleasant sensory or emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” Among many other variables, mental health conditions play a critical role in determining the emotional experience. Thus, it is very reasonable to hypothesize that baseline anxiety, for instance, may influence pain and opioid prescribing. In this month's RAPM Focus, Editor-in-Chief Brian Sites, MD, joins Shay Nguyen and Jennifer Waljee, MD, authors on “Prospective cohort study on the trajectory and association of perioperative anxiety and postoperative opioid-related outcomes,” first published in August 2022 (https://rapm.bmj.com/content/47/10/637). In this fascinating study, 1,771 patients were prospectively followed; self-reported opioid use, pain, and anxiety were recorded on the day of surgery and at 1-, 3-, and 6-months post-surgery to examine whether or not anxiety was a mediator between pain and opioid use. Shay N. Nguyen is a fourth-year medical student at the University of Michigan who is applying into classic surgery. She studied biochemistry in the University of California, Santa Barba, where she did research in chemistry and material science. Currently, her research interests include understanding risk factors for opioid use in the context of surgery and perioperative anxiety management. Dr. Jennifer F. Waljee is a plastic surgeon in academic practice at the University of Michigan. She completed her medical school training at Emory University and completed clinical residencies in general surgery and plastic surgery at the University of Michigan, followed by a hand surgery fellowship. Dr. Waljee is a co-founder and co-director of the Michigan Opioid Prescribing Engagement Network (OPEN), a statewide collaborative program dedicated to enhancing opioid stewardship and developing best practices for the management of acute pain during procedural care. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others.

The International Association for the Study of Pain defines pain as: “An unpleasant sensory or emotional experience associated with, or resembling that associated with, actual or potential tissue damage. Pain is both a disease and a symptom.” The inclusion of the word emotional in the definition alludes to the fact that consciousness is part of the pain pathway. Despite the knowledge that neurocognitive aspects of human psychology are intimately related to pain, very little research exists examining behavioral interventions. In this month's RAPM Focus, Editor-in-Chief Brian Sites, MD, joins Jessie Markovits, MD, the lead author of “Effects of hypnosis versus enhanced standard of care on postoperative opioid use after total knee arthroplasty: the HYPNO-TKA randomized clinical trial,” first published in June 2022 (https://rapm.bmj.com/content/47/9/534). In this provocative study, 64 patients got either a 10-minute hypnosis session or an enhanced control during a hospital medicine pre-op visit before total knee arthroplasty. Dr. Jessie Markovits completed medical school at Tulane School of Medicine in New Orleans, followed by an internal medicine residency at Stanford. Her current appointment is associate professor of medicine, with a courtesy appointment to psychiatry and behavioral sciences at Stanford University. She is board-certified in internal medicine and has developed a perioperative specialization over the past 6 years in her clinical role as surgical co-management hospitalist, primarily for orthopedic surgery. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others.

Systematic reviews and meta-analyses are the main drivers of policy, evidence-based guidelines, and funding decisions, but many of them are fraught with errors, and the resources needed to peer-review them are massive. A recent systematic review examined the quality of the current published meta-analyses in order to inform the design and reporting of future studies. In this month's RAPM Focus, Editor-in-Chief Brian Sites, MD, joins John Kramer MSc, PhD, the senior author of “Quality of meta-analyses of non-opioid, pharmacological, perioperative interventions for chronic postsurgical pain: a systematic review,” first published in January 2022 (https://rapm.bmj.com/content/47/4/263). The systematic review explored the idea that surgery may represent an environment, known as a transitional pain state, that could result in a patient developing chronic pain following surgery. Dr. John Kramer is an associate professor in the faculty of medicine, department of anesthesiology, pharmacology and therapeutics, and principal investigator at ICORD at the University of British Columbia in Vancouver, Canada. His lab is focused on improving outcomes for individuals with spinal cord injury and neuropathic pain. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on Twitter @RAPMOnline.

In surgical care worldwide, there has been a growing trend towards enhanced recovery with the emphasis on early mobility, avoidance of unnecessary procedures and drug-induced side effects, and faster return of normal gastrointestinal function, with the end result of shorter hospital stay. It's natural to assume that regional anesthesiology and acute pain medicine would play a central role in enhanced recovery protocols for all of the well-described benefits. However, the base evidence is continually evolving as both anesthetic and surgical practices change. In this month's RAPM Focus, Associate Editor Edward Mariano, MD, joins Kariem El-Boghdadly, MBBS, BSc, FRCA, EDRA, lead author of an international collaboration in the regional anesthesiology and enhanced recovery world, “Role of regional anesthesia and analgesia in enhanced recovery after colorectal surgery: a systematic review of randomized controlled trials,” first published in March 2022 (https://rapm.bmj.com/content/47/5/282). Investigators carefully evaluated thirteen published randomized controlled trial studies involving 1,170 participants and concluded that regional analgesia may only have modest evidence to support its inclusion in enhanced recovery protocols involving colorectal surgery patients. Dr. Kariem El-Boghdadly is a consultant anesthetist at Guy's and St. Thomas' NHS Trust in London, and an editor of the journal Anesthesia. Dr. El-Boghdadly completed his undergraduate training at University College of London in 2007 and proceeded to undertake his anesthetic training in Southeast School of Anesthesia. He was awarded the Nuffield Prize for the fellowship of the Royal College of Anaesthetists and completed fellowships in prehospital medicine in Australia, followed by regional anesthesia in Toronto, Canada. Dr. El-Boghdadly is an honorary senior lecturer at King's College London, and his research interests include regional anesthesia, airway management, and research delivery. He is a brilliant researcher and writer and is well-known for his work in the COVIDSurg Collaborative during the ongoing pandemic, and the ASRA-ESRA regional anesthesia nomenclature project. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on Twitter @RAPMOnline.

Establishing new clinical pathways and accomplishing change often takes a super-human effort in a complex health system. In terms of systemic lidocaine, the analgesic effects of systemic lidocaine are well recognized, but what is novel is the application of this therapy in an environment once thought to be inappropriate, that is, in the general inpatient units. In this month's RAPM Focus, Editor-in-Chief Brian Sites, MD, joins Meagan Miller, APRN, MSN, AGACNP-BC, and Brian Allen, MD, to discuss their university-based study, “Safety of postoperative lidocaine infusions on general care wards without continuous cardiac monitoring in an established enhanced recovery program,” first published in January 2022 (https://rapm.bmj.com/content/47/5/320). Meagan Miller graduated from the University of Alabama with her bachelor's in nursing in 2012. She was then accepted into Vanderbilt University Medical Center Nurse Residency Program and joined the colorectal and general surgery floor, which sparked her interest in enhanced recovery after surgery, as it was the first floor to initiate lidocaine infusions outside of the ICU. She has her master's in nursing science in adult gerontology acute care nurse practitioner and first assist. Dr. Brian Allen is an associate professor at Vanderbilt University Medical Center, where he directs the fellowship in regional anesthesiology and acute pain medicine. He completed undergraduate in medical school at Washington University. He was a resident at Vanderbilt and did his regional fellowship at Oregon Health & Science University (OHSU) before returning to join the Vanderbilt faculty. His clinical focus is on regional and multimodal analgesia in ERAS pathways. His research interests include educational assessment, evaluating ERAS efficiency, efficacy and compliance, and opioid minimization. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on Twitter @RAPMOnline.

Systematic reviews and meta-analyses are incredibly important; they drive clinical practice, policy, and reimbursement, but unfortunately, take a team of people and a significant amount of time. In this month's RAPM Focus, Editor-in-Chief Brian Sites, MD, joins Joshua Myszewski and Kristopher Schroder, MD, to discuss their exploratory study, “Evaluation of language analysis to summarize the literature: a comparison to traditional meta-analysis in primary hip and knee surgery,” first published in December 2021 (https://rapm.bmj.com/content/47/3/151). The study used something known as “sentiment analysis,” a computer-based tool, to evaluate 115 article abstracts from studies that were included in a recent systematic review and meta-analysis on total joint arthroplasty. The idea of the study was to evaluate if a sentiment analysis could come to similar conclusions as a full meta-analysis. Joshua Myszewski is a second-year medical student at the University of Wisconsin School of Medicine. Since starting medical school, he's been working on applying his previous engineering research experience to the clinical domain. He has an undergraduate background in engineering, and first began working with machine learning and artificial intelligence as an undergraduate. He has worked on the development of EEG-based brain computer interfaces for disabled patients. Dr. Kristopher Schroeder is vice-chair of faculty development at the University of Wisconsin. Within ASRA Pain Medicine, he has served as the Editor for the ASRA Pain Medicine News from 2018-2021 and was honored to be one of the founding members of the Physician Mentorship and Leadership Development Special Interest Group. He assisted his wife, veterinarian Carrie Schroeder, in performing the first-ever recorded transversus abdominis plane (TAP) block on a lynx. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on Twitter @RAPMOnline.

The impact of the type of anesthesia on perioperative outcomes has been the subject of much debate. Observational data suggests that neuraxial anesthesia may provide benefits over general anesthesia, especially in the orthopedic population; however, it remains unclear if these benefits can be materialized in all subpopulations. In this month's RAPM Focus, Executive Editor Stavros Memtsoudis, MD, PhD, interviews Edward Yap, MD, the first author of “Neuraxial and general anesthesia for outpatient total joint arthroplasty result in similarly low rates of major perioperative complications: a multicentered cohort study,” first published online in January 2022 (https://rapm.bmj.com/content/47/5/294). The study used introspective data from cases performed in 21 centers in the Kaiser Permanente Northern California system between 2017-2019, with the primary goal to compare perioperative outcomes between procedures performed with neuraxial anesthesia and general anesthesia. Dr. Yap is a senior physician and anesthesiologist with the Kaiser Permanente South San Francisco Medical Group and a volunteer assistant professor with the University of California San Francisco. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on Twitter @RAPMOnline.

Buprenorphine is an incredibly safe and effective drug as both an analgesic as well as a front-line therapy for the treatment of an opioid use disorder (OUD). However, decisions around the management of this drug in the perioperative period have generated substantial confusion and anxiety amongst patients, policymakers, and healthcare providers. In this month's “RAPM Focus,” Editor-in-Chief Brian Sites, MD, interviews Lynn Kohan, MD, the senior author of “Buprenorphine management in the perioperative period: educational review and recommendations from a multisociety expert panel,” first published in August 2021 (https://rapm.bmj.com/content/46/10/840). This multi-center and multi-disciplinary project establishes expert recommendations for the perioperative management of patients with OUD and brings clarity to many of these questions. Dr. Kohan is an associate professor of anesthesiology and pain medicine at the University of Virginia (UVA) Pain Management Center. She did her anesthesiology residency at Georgetown University and her pain fellowship at UVA. She has served as the chronic pain fellowship director for the past several years and was recently appointed division chief of pan medicine. She is actively involved with ASRA Pain Medicine, serving as the chair of the membership committee. In addition, she holds leadership positions in the area of education, serving as the president-elect of the Association of Pain Program Directors, council member of the Society of Academic Associations of Anesthesiology and Perioperative Medicine, and the chair of the fellowship committee at the American Academy of Pain Medicine. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on Twitter @RAPMOnline.

There is much political, professional, and cultural debate around the impact that cannabinoids, good or bad, have on health and wellbeing. This month's “RAPM Focus,” evaluates the relationship between cannabis use and sleep patterns among adult Americans. Editor-in-Chief Brian Sites, MD, interviews authors Calvin Diep, MD, and Karim Ladha, MD, on the paper “Recent cannabis use and nightly sleep duration in adults: a population analysis of the NHANES from 2005 to 2018,” first published in December 2021 (https://rapm.bmj.com/content/47/2/100). The study used observational data from the National Health and Nutrition Examination Survey (NHANES) and examined whether recent use of cannabinoids impacted on incidence of too little sleep or too much sleep. Dr. Diap is a second-year resident in the Department of Anesthesiology and Pain Medicine at the University of Toronto. He is also enrolled in the clinician investigator program and will be starting his graduate studies at the Institute of Health Policy Management at the University of Toronto. His research interests lie in using clinician epidemiological methods to study patient-centered outcomes in the perioperative period, such as pain and disability, as well as opioid and cannabinoid use patterns at population levels. Dr. Ladha is a clinician scientist and staff anesthesiologist at St. Michael's Hospital at the University of Toronto. He received his medical degree from the Johns Hopkins University School of Medicine. He then completed his anesthesia training at the Massachusetts General Hospital and obtained a master's degree in clinical epidemiology from the Harvard School of Public Health. His research uses mixed methodologies to obtain a multi-faceted view of pain and recovery after surgery, including retrospective analyses of administrative databases and prospective observational studies in multi-center randomized controlled trials. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. Podcast and music produced by Dan Langa. Find us on Twitter @RAPMOnline.

This month's “RAPM Focus” highlights a small study conducted by a team out of the University of California San Diego, designed to determine if percutaneous cryoneurolysis of the lateral femoral cutaneous nerve is feasible and shows potential for future study in management of burn patients. Dr. John J. Finneran is the first author of “Percutaneous cryoneurolysis of the lateral femoral cutaneous nerve for analgesia following skin grafting: a randomized, controlled pilot study,” published first in August 2021 and subsequently in the January 2022 print edition (https://rapm.bmj.com/content/47/1/60). As Dr. Finneran reported in the paper, peripheral nerve blocks may be used for postoperative analgesia following split thickness skin graft, and the lateral femoral cutaneous nerve is “an optimal target, since it innervates the lateral thigh and has no motor component.” However, because local anesthetic nerve blocks are limited in their duration, this study looked at the use of ultrasound-guided percutaneous cyroneurolysis for extended analgesic effect. The results were promising, with the patients who were randomized to the cryoneurolysis group having lower average and maximum pain scores, less need for opioid analgesics, and fewer reports of sleep disturbances during the first two nights after surgery. Listen in as Dr. Finneran describes the study, the procedure, and future research objectives. Dr. Finneran is a Health Sciences clinical associate professor and associate residency program director in the Department of Anesthesiology at the University of California San Diego, as well as clinical director for Regional Anesthesiology at UC San Diego Medical Center – Hillcrest. *The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice, and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care, or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others. @RAPM_Online

This month's “RAPM Focus” looks at evidence-based practices to improve the creation and delivery of medical education lectures. Editor-in-Chief Brian Sites, MD, interviews Monica W. Harbell, MD, first author of the paper “Reviving the medical lecture: practical tips for delivering effective lectures,” published in the March 2022 issue of Regional Anesthesia & Pain Medicine (https://rapm.bmj.com/content/47/5/331). In the paper, Dr. Harbell and coauthor Dr. Patricia S. O'Sullivan outline nine specific tips for effective presentations including the importance of learning objectives, content organization, effective visuals, simple slide design, and others. They also provide tips to keep your audience interested and engaged, particularly in an increasingly virtual world. Dr. Harbell is an assistant professor in the Department of Anesthesiology and Perioperative medicine at the Mayo Clinic in Arizona and the associate program director for the Mayo Clinic Arizona Anesthesiology residency. She is the chair of the American Society of Anesthesiologists (ASA) Committee on Patient Safety and Education and a member of the ASA committee on practice parameters.

In the first episode of RAPM Focus, Editor-in-Chief Brian Sites, MD, interviews Stephen P. Cohen, MD, first author of the paper “Multicenter study evaluating factors associated with treatment outcome for low back pain injections”. This prospective study looked at 346 patients receiving one of three procedures: epidural steroid injection for sciatica, sacroiliac joint injections for axial low back pain, and facet interventions for axial low back pain. The study was designed to evaluate associations among more than two dozen demographic, clinical, and technical factors on treatment outcomes. Results found that patients with lower baseline pain scores, depressive symptomatology, and obesity experienced smaller pain reductions. Smoking and sleep deprivation were also associated with poorer outcomes. Dr. Cohen is a professor of anesthesiology and critical care medicine, neurology, physical medicine & rehabilitation and psychiatry and behavioral sciences at the Johns Hopkins School of Medicine and Uniformed Services University of the Health Sciences in Baltimore, MD. He is also chief of pain medicine and director of the Blaustein Pain Treatment Center at Johns Hopkins and director of pain research at Walter Reed National Military Medical Center. @RAPM_Online