RAPM Focus

Episode 6: Neuraxial & General Anesthesia for TJA Show Similar Rates of Perioperative Complications

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.

Episode 5: Buprenorphine Management in the Perioperative Period: Review and Recommendations

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.

Episode 4: Recent Cannabis Use and Nightly Sleep Duration in Adults

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.

Episode 3: Percutaneous Cryoneurolysis of the LFCN for Analgesia Following Skin Grafting.

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

Episode 2: Reviving the medical lecture: practical tips for delivering effective lectures

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.

First episode: Factors associated with treatment outcomes for low back pain injections

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