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.