RAPM Focus

Article Reads Episode 1

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

Episode 29: Best Practice Advisories and Policies with Systematic Reviews

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.

Episode 28: Challenges within the Scientific Publishing Landscape

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.

Episode 27: Crystallization of mixtures of local anesthetics with and without select adjuvants: a semiquantitative light microscopy analysis

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.

Episode 26: Perioperative considerations for patients exposed to hallucinogens

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.

Episode 25: Evaluating residual anti-Xa levels following discontinuation of treatment-dose enoxaparin in patients presenting for elective surgery: a prospective observational trial

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.

Message from RAPM Editor–In–Chief, by Brian D. SITES

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/.

Episode 24: Incidence of persistent opioid use following traumatic injury

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

Episode 23: Real-world study of intranasal ketamine for use in patients with refractory chronic migraine

RAPM Editor-in-Chief Brian Sites, MD, joins Hsiangkuo Yua, MD, PhD, and Aniket Natekar, MD, twocoauthors of “Real-world study of intranasal ketamine for use in patients with refractory chronicmigraine,” 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 asa research fellow, then completed a neurology residency and headache fellowship at Thomas JeffersonUniversity. Dr. Yuan is currently an associate professor of neurology and the director of clinical researchat the Jefferson Headache Center. He is also the vice chair of ASRA Headache SIG and an associate editorof RAPM. His research interests include real world analysis of novel migraine therapeutics and afundamental 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 theUniversity 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 atthe Jefferson Headache Center. Dr. Natekar is currently a practicing neurologist with a subspecialtytraining in headache management.Migraine is a common and disabling headache disorder with huge societal implications in terms ofhuman suffering and loss of productivity. The World Health Organization recognizes its importance byranking it in seventh place among worldwide diseases causing disability. Refractory chronic migraineheadache is a subset condition of migraines. As the name suggests, it is an extremely unfortunatesituation with limited treatment options.*The purpose of this podcast is to educate and to inform. The content of this podcast does notconstitute medical advice, and it is not intended to function as a substitute for a healthcarepractitioner’s judgement, patient care, or treatment. The views expressed by contributors are those ofthe speakers. BMJ does not endorse any views or recommendations discussed or expressed on thispodcast. Listeners should also be aware that professionals in the field may have different opinions. Bylistening to this podcast, listeners agree not to use its content as the basis for their own medicaltreatment 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

Episode 22: Rate of occurrence of respiratory complications in patients who undergo shoulder arthroplasty with a continuous interscalene brachial plexus block and associated risk factors.

RAPM Editor-in-Chief Brian Sites, MD, joins Lei Xu, MD, and Ed Mariano, MD, MAS, FASA, FASRA, twocoauthors of “Rate of occurrence of respiratory complications in patients who undergo shoulderarthroplasty with a continuous interscalene brachial plexus block and associated risk factors,” firstpublished in May 2023.Dr. Xu is a clinical assistant professor in the department of anesthesiology at Stanford. She received hermedical degree from Stanford before completing her residency in anesthesiology at the University ofCalifornia San Francisco, and then a fellowship in regional anesthesia and acute pain medicine atStanford. She is interested in the application of regional anesthesia outside the operating room. Herresearch interests include studying the functional outcomes of clinical pathways that include regionalanesthesia 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 hasdeveloped techniques and patient care pathways to improve post-operative pain, patient safety, andother outcomes, and has published over 250 peer-reviewed articles. He has held leadership positions inthe California Society of Anesthesiologists, American Society of Anesthesiologists, American Society ofRegional Anesthesia and Pain Medicine, and multiple journal editorial boards.In their retrospective observational study, over 1,000 patients were evaluated undergoing total shoulderreplacement with a continuous interscalene block. Respiratory complications were categorized into fourgroups: none, mild, moderate, and severe. Interscalene blocks are important to the success of thesesurgeries, but there remain concerns about respiratory morbidity.*The purpose of this podcast is to educate and to inform. The content of this podcast does notconstitute medical advice, and it is not intended to function as a substitute for a healthcarepractitioner’s judgement, patient care, or treatment. The views expressed by contributors are those ofthe speakers. BMJ does not endorse any views or recommendations discussed or expressed on thispodcast. Listeners should also be aware that professionals in the field may have different opinions. Bylistening to this podcast, listeners agree not to use its content as the basis for their own medicaltreatment 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