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Regional Anesthesia & Pain Medicine

RAPM is your authoritative medical source for regional anesthesia and pain knowledge – from pediatric

09/03/2026

🦶 Five nerves. Two punctures.

This ultrasound-guided ankle block targets all five terminal nerves of the foot through only two skin punctures, aiming to simplify regional anesthesia for outpatient foot surgery.

✨ Key findings:
• 80 patients undergoing outpatient foot surgery
• Surgical anesthesia achieved in 77 patients (96%)
• Median pain score during block placement: 0
• Median analgesia duration: 690 minutes
• No block-related complications were observed

🔍 This anatomically guided approach may simplify ankle blocks while preserving proximal lower-leg motor function. Comparative studies are still needed.

📖 Deffontis L, Herteleer M, Roger C, et al.

🔗 Read the full article in RAPM: https://doi.org/10.1136/rapm-2026-108097

09/01/2026

🧠 A New Molecular Target in Neuropathic Pain?

In a mouse model of nerve injury, protein tyrosine phosphatase 1B (PTP1B) was upregulated in dorsal root ganglion nociceptors and contributed to neuropathic pain-like behaviors.

✨ Key findings:

• PTP1B increased after peripheral nerve injury
• Targeted PTP1B knockdown reduced established pain hypersensitivity
• PTP1B activated the Src/GluN2B pathway
• This increased presynaptic glutamate release in the spinal dorsal horn

🔍 These preclinical findings identify a potential new therapeutic target for neuropathic pain, including diabetic neuropathy.

📖 Li X-Q, Wu S-J, Sun R-L, et al.

🔗 Discover more in RAPM: https://doi.org/10.1136/rapm-2026-107766

08/27/2026

📢 🩸 Call for Submissions: Regional Anesthesia in Patients with Coagulopathy or Anticoagulation 🩸 📢

We invite original research, systematic reviews, and clinical perspectives exploring:

-Safe timing windows and monitoring for newer direct oral anticoagulants (DOACs)

-Risk-benefit profiles of superficial vs. deep/non-compressible nerve blocks

-Management of patients with acquired or congenital coagulopathies

-Protocols for urgent or emergent regional interventions

📅 Submission Deadline: February 5, 2027

📖 Submit your manuscript here -> https://bit.ly/45Hzcfh

08/23/2026

🧠⚡ Glutamatergic neurons in the nucleus accumbens represent a distinct functional population that gates pain

A new study in RAPM identified a distinct population of VGluT2 glutamatergic neurons in the NAc that may play a critical role in persistent inflammatory pain.

🔑 Key findings:
• 🧠 NAc VGluT2 neurons represent a unique non-GABAergic neuronal population.
• ⚡ More than 90% demonstrated intrinsic burst-firing activity.
• 🔥 These neurons became significantly hyperexcitable during inflammatory pain.
• 🛑 Chemogenetic inhibition reduced mechanical and thermal pain hypersensitivity.
• 😰 Modulating these neurons also bidirectionally altered pain-related anxiety-like behaviors.

💡 Why does this matter?

These findings identify a previously underappreciated NAc microcircuit that may simultaneously influence persistent pain and its emotional consequences, opening the door to more precise circuit-based approaches to pain treatment. 🚀

📖 Si et al. - https://doi.org/10.1136/rapm-2026-107870

08/21/2026

🔌 Limited predictive utility of spinal cord stimulation trial pain metrics for post-implant outcomes

A new study in RAPM examined 124 patients who underwent SCS trial and implantation, following pain outcomes from 1 month through 36 months post-implantation.

🔑 Key findings:
• 📉 Patients experienced substantial pain reduction after the SCS trial, with benefits sustained—but gradually attenuating—through 36 months.
• 📊 Change in NRS pain scores demonstrated the strongest predictive value for longer-term outcomes, although overall predictive power remained modest.
• 🎯 Post-trial NRS was the strongest predictor of achieving ≥50% long-term pain relief.
• ⚖️ Patient-reported percentage pain relief and calculated percentage pain relief showed poor agreement, highlighting concerns about the reproducibility of percentage-based metrics.
• 🧩 No consistent baseline patient characteristics were identified that significantly modified the relationship between trial outcomes and post-implant pain relief.

💡 The takeaway:
While SCS trials remain an important component of patient selection, trial-phase pain metrics alone may not reliably predict long-term post-implant outcomes. These findings underscore the need for more reliable and reproducible predictors of SCS success.

📖 Keith et al. - https://doi.org/10.1136/rapm-2026-108028

08/19/2026

🎙️ Can GLP-1 receptor agonists change the trajectory of knee osteoarthritis?

In the latest episode of RAPM Focus, Executive Editor Anahi Perlas, MD, FRCPC, sits down with Ryan D’Souza, MD, and Jay Karri, MD, to discuss an intriguing question:

🦵 Could GLP-1 receptor agonists reduce the risk of progression to total knee arthroplasty?

Their conversation explores findings from their recently published retrospective database analysis examining the association between GLP-1 receptor agonist use and arthroplasty risk in patients with knee osteoarthritis.

💡 Why this matters: As GLP-1 receptor agonists continue to transform obesity and metabolic disease management, their potential effects on musculoskeletal health and chronic pain are an exciting area for further investigation.

🎧 Tune in to the newest RAPM Focus podcast to hear the authors discuss the study, its implications, and what questions remain unanswered.

👂 Listen Here -> https://rapmfocusbmj.podbean.com/e/episode-54-glucagon-like-peptide-1-receptor-agonist-use-and-risk-of-arthroplasty-for-knee-osteoarthritis-retrospective-database-analysis/

08/17/2026

🦵💉 Systemic Lidocaine vs. Adductor Canal Block In Patients Undergoing Total Knee Arthroplasty

A recent non-inferiority trial of 120 patients compared IV lidocaine infusion with ultrasound-guided adductor canal block for postoperative pain and opioid consumption.

🔑 Key findings:
• 💊 24-hour opioid consumption was non-inferior with IV lidocaine
• 🏥 Adductor canal block provided better immediate PACU analgesia
• ⏱️ Pain control and analgesic needs were otherwise comparable after PACU
• 😊 Quality of recovery and patient satisfaction were similar
• 🛡️ No study-related adverse events were reported

📌 Bottom line: IV lidocaine may be a useful alternative when regional anesthesia is not feasible, while adductor canal block may still offer an advantage for immediate postoperative analgesia.

📖 Ramanujam et al. - https://doi.org/10.1136/rapm-2026-107976

08/13/2026

💉 Is the PENG block really a pericapsular block?

A new multimodal anatomical study combining dissection, cryo-cross-sections, and histology provides important evidence about where injectate actually spreads.

🔹 Injectate remained predominantly within the iliacus and iliopsoas muscles.
🔹 No consistent spread to the hip capsule was observed.
🔹 Histology revealed small intramuscular nerve branches, supporting intramuscular neural blockade as a potential mechanism of analgesia.
🔹 The findings may also explain occasional femoral nerve involvement.

This work offers new insight into the anatomical basis of one of the most widely discussed hip blocks in regional anesthesia.

📖 Read the full article: https://doi.org/10.1136/rapm-2026-107853

08/10/2026

🧠 60-Day Percutaneous Peripheral Nerve Stimulation for Chronic Pain

Temporary percutaneous peripheral nerve stimulation (PNS) is an emerging neuromodulation strategy for chronic pain, but how does it perform in routine clinical practice?

✨ Key findings:
• 125 patients treated in two academic centers
• 24% of patients receiving PNS achieved clinically meaningful pain relief
• 19% underwent early device removal
• Mental health comorbidities were present in 54% of patients

🔍 Real-world outcomes with PNS were more modest than those reported in indication-specific clinical trials, emphasizing the importance of patient selection and long-term follow-up.

📖 Chiang MC, Smith MR, Karri J, et al.

👉 Read the full article in RAPM: https://doi.org/10.1136/rapm-2026-108123

08/08/2026

🦵 Femoral or adductor canal catheter for anterior cruciate ligament reconstruction?

A double-blind randomized trial compared continuous femoral nerve block (CFNB) with continuous adductor canal block (CACB) after anterior cruciate ligament reconstruction.

✨ Key findings:
• No difference in average pain over the first 48 hours
• Lower immediate postoperative pain with CFNB
• Fewer CFNB patients required >50 MME in an exploratory analysis
• Similar quality of recovery and rehabilitation compliance

🔍 Although CFNB was not superior for the primary pain outcome, it may provide better early analgesia while the clinical trade-off with quadriceps weakness requires further investigation.

📖 Chen JC et al.

👉 Read the full article in RAPM: https://doi.org/10.1136/rapm-2026-107940

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