Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Feb 2025
Role of spinal Barrier-to-Autointegration Factor (BAF) in the epigenetic silencing of the mu-opioid receptor gene in neuropathic pain.
Neuropathic pain presents a significant clinical challenge, with spinal cord epigenetic mechanisms playing a critical role in its development. This study investigated the impact of nerve injury on the Barrier-to-Autointegration Factor (BAF) in the rat spinal dorsal horn. ⋯ These findings suggest that spinal pNR2B receptors may activate BAF, which interacts with LEMD2 to enhance EZH2-mediated H3K27me3 at the mu-opioid receptor promoter after nerve injury. Targeting this pathway may offer novel strategies to inhibit neuropathic pain.
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Reg Anesth Pain Med · Feb 2025
Review Meta AnalysisPrevalence of and recommendation for measuring chronic postsurgical pain in children: an updated systematic review and meta-analysis.
According to the prior 2017 review (Rabbitts et al), approximately 20% of children and adolescents develop chronic postsurgical pain (CPSP; ie, pain persisting >3 months after surgery) after major surgeries, which is associated with adverse functional and psychological consequences. A major barrier was that definitions of CPSP applied were highly variable. Since that prior review was conducted (n=4 studies in meta-analysis), numerous relevant studies have been published warranting an update. ⋯ CRD42022306340.
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Reg Anesth Pain Med · Feb 2025
ReviewPostamputation pain: a multidisciplinary review of epidemiology, mechanisms, prevention, and treatment.
Despite humanity's long experience with amputations, postamputation pain remains a highly prevalent, incompletely understood, and clinically challenging condition. There are two main types of postamputation pain: residual limb pain (including but not limited to the "stump") and phantom limb pain. ⋯ Central, peripheral, and spinal mechanisms may all contribute to the protean manifestations of persistent postamputation pain; an improved understanding of these mechanisms will be essential to identify the most promising interventions for the prevention and treatment of postamputation pain. Although there are currently no standardized prevention or treatment recommendations for any type of postamputation pain, an evidence-based, multimodal strategy including pharmacological agents, nonsurgical procedures, surgery, complementary and integrative techniques, and assistive technologies may prevent the development of chronic postamputation pain after amputation and/or optimize treatment outcomes.
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Reg Anesth Pain Med · Feb 2025
ReviewEvidence for regional anesthesia in preventing chronic postsurgical pain.
Chronic postsurgical pain (CPSP) is a common adverse outcome following surgical procedures. Despite ongoing research, the risk factors and effective strategies for mitigating CPSP remain uncertain. Regional anesthesia is a potentially beneficial yet debated intervention for mitigating the risk of CPSP. ⋯ Techniques studied include wound infiltration, peripheral nerve blocks, fascial plane blocks, thoracic paravertebral blocks and epidural anesthesia. Current data indicate that epidural anesthesia might decrease CPSP risk following thoracotomy, wound infiltration may be effective after major breast surgery and cesarean delivery, and serratus anterior plane block or pectoralis/interpectoral plane blocks might be beneficial in breast surgery. However, the existing evidence is limited and marked by several constraints especially the multifactorial causes, underscoring the need for further research in this area.