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RAPM Focus is a podcast devoted to exploring the provocative and impactful aspects of the research published in Regional Anesthesia & Pain Medicine (RAPM). Authors of articles from the journal are joined by Editor-in-Chief, Dr. Brian Sites, and other members of the RAPM Editorial Board to discuss and debate the findings that matter most for clinicians, patients, and policy makers.
At RAPM, we believe well-done pain medicine improves health and well-being. Thanks for joining us.
@RAPM_Online
 
Podcast and music produced by Dan Langa.
 
* 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 Focus

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.

Episode 9: Role of Regional Anesthesia and Analgesia in Enhanced Recovery After Colorectal Surgery

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.

Episode 10: Quality of Meta-Analyses of Perioperative Interventions for Chronic Postsurgical Pain

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.

Episode 11: Effects of Hypnosis on Postoperative Opioid Use After Total Knee Arthroplasty

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.

Episode 12: Association of Perioperative Anxiety and Postoperative Opioid-Related Outcomes

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.

Episode 13: Lumbar Medial Branch Blocks: How Does The Second Block Influence Progression?

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