RAPM Focus

In this special episode, RAPM Focus takes a break from its usual format of discussing specific research projects to discuss instead how research in health care is increasingly vital yet often hindered by escalating costs and time constraints. Editor-in-Chief Brian Sites, MD, discusses these challenges with Alexander (Xan) Abess, MD, and Jonathan Weed, MD. Traditional, large scale, randomized controlled trials are resource intensive, making them challenging for clinicians to conduct. As a result, innovative approaches to engage in knowledge acquisition are becoming paramount. Creating a scholastic environment within the anesthesia department not only fosters a culture of continuous learning, but also becomes essential for attracting and retaining talent. Dr. Abess is an anesthesiologist at Dartmouth Hitchcock Medical Center and assistant professor of anesthesiology and perioperative medicine at Geisel School of Medicine at Dartmouth. He has previously served as the vice chair of quality and safety, department of anesthesiology and perioperative medicine, and is actively involved with the Multi-Center Perioperative Outcomes Group (MPOG). He is the founder and Director of IDEA Lab (Innovation, Development, and Entrepreneurship in Anesthesiology). Xan has a wide range of clinical experience (private practice, academic medicine, military medicine) and medical device development experience, having previously started his own medical device company. He understands well the challenges of medical innovation and truly enjoys helping others achieve their development goals while also attempting to improve the quality of health care delivery and simultaneously addressing our broader economic and workforce challenges. Dr. Weed is a clinical assistant professor of anesthesiology at Dartmouth Hitchcock Medical Center. He is a graduate of Tulane Medical School and completed his anesthesiology residency at Beth Israel Deaconess Medical Center, followed by a fellowship at Dartmouth Hitchcock Medical Center in regional anesthesia. He spent several years as a residency program director at Tulane Medical Center before returning to Tulane Medical Center in 2021. His most recent interests relate to the use of the electronic health record to improve clinical workflow in research within the department. *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 health care practitioner’s judgment, 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.

In this episode of RAPM Focus, Editor-in-Chief Brian Sites, MD, is delighted to be joined by Alexander Stone, MD, and Kamen Vlassakov, MD, following the April 2024 publication of their original research paper, “Anesthesia Start Time Documentation Accuracy where Peripheral Nerve Block is the Primary Anesthetic.” Understanding the intricacies of billing is crucial for anesthesiologists in all practice settings, not just in private practice. Proper billing practices not only ensure fair compensation for services rendered, but also impact patient care, hospital finances, and overall health care delivery. Anesthesiologists who engage with billing gain a better understanding of health care economics, which is essential for navigating the complex landscape of modern health care. Dr. Stone is a regional anesthesiologist at Brigham and Women’s Hospital. He is an assistant professor of anesthesia at Harvard Medical School and Associate Editor of RAPM. Dr. Vlassakov is the chief of the division of regional and orthopedic anesthesiology, as well as the program director of the regional anesthesiology and acute pain medicine fellowship at Brigham and Women’s Hospital. He is an associate professor of anesthesia at Harvard Medical School and also an Associate Editor of RAPM. *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.

In this episode of RAPM Focus, Editor-in-Chief Brian Sites, MD, is delighted to be joined by Ryan D’Souza, MD, and Nasir Hussain, MD, following the February 2024 publication of their review, “Methodological and Statistical Characteristics of Meta-Analyses on Spinal Cord Stimulation for Chronic Pain: A Systematic Review.” Both of these anesthesiologists are prolific in their research and contributions to the regional anesthesia and pain medicine community. 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. The mathematical principles and assumptions of systematic reviews and meta-analyses are quite complex, which often exceeds the capacity of many journals to truly adjudicate. To further complicate matters, there are emerging techniques that include network meta-analyses that take even more expertise to review. Therefore, better understanding content areas where there are strengths and weaknesses around systematic reviews is critical to best informing clinical practice. Dr. D’Souza is a pain medicine physician and anesthesiologist at the Mayo Clinic. He is an associate professor, director of neuromodulation, and director of the in-patient pain service. He is an associate editor and social media editor for RAPM. Dr. Hussain is a pain medicine physician and anesthesiologist at the Ohio State University Wexner Medical Center. He is an assistant professor, associate program director for anesthesiology residency, and assistant program director of the chronic pain fellowship. *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.

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

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: *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.

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.

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.

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.

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.

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/.

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

RAPM Editor-in-Chief Brian Sites, MD, joins Hsiangkuo Yua, MD, PhD, and Aniket Natekar, MD, two coauthors of “Real-world study of intranasal ketamine for use in patients with refractory chronic migraine,” 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 as a research fellow, then completed a neurology residency and headache fellowship at Thomas Jefferson University. Dr. Yuan is currently an associate professor of neurology and the director of clinical research at the Jefferson Headache Center. He is also the vice chair of ASRA Headache SIG and an associate editor of RAPM. His research interests include real world analysis of novel migraine therapeutics and a fundamental 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 the University 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 at the Jefferson Headache Center. Dr. Natekar is currently a practicing neurologist with a subspecialty training in headache management. Migraine is a common and disabling headache disorder with huge societal implications in terms of human suffering and loss of productivity. The World Health Organization recognizes its importance by ranking it in seventh place among worldwide diseases causing disability. Refractory chronic migraine headache is a subset condition of migraines. As the name suggests, it is an extremely unfortunate situation with limited treatment options. *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. #headache #headachedisorder #migraine #refractorychronicmigraine #respiratorycomplications #intranasalketamine #regionalanesthesia #chronicpain #anesthesia #pain #painmanagement #MedEd #medicine

RAPM Editor-in-Chief Brian Sites, MD, joins Lei Xu, MD, and Ed Mariano, MD, MAS, FASA, FASRA, two coauthors of “Rate of occurrence of respiratory complications in patients who undergo shoulder arthroplasty with a continuous interscalene brachial plexus block and associated risk factors,” first published in May 2023. Dr. Xu is a clinical assistant professor in the department of anesthesiology at Stanford. She received her medical degree from Stanford before completing her residency in anesthesiology at the University of California San Francisco, and then a fellowship in regional anesthesia and acute pain medicine at Stanford. She is interested in the application of regional anesthesia outside the operating room. Her research interests include studying the functional outcomes of clinical pathways that include regional anesthesia 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 has developed techniques and patient care pathways to improve post-operative pain, patient safety, and other outcomes, and has published over 250 peer-reviewed articles. He has held leadership positions in the California Society of Anesthesiologists, American Society of Anesthesiologists, American Society of Regional Anesthesia and Pain Medicine, and multiple journal editorial boards. In their retrospective observational study, over 1,000 patients were evaluated undergoing total shoulder replacement with a continuous interscalene block. Respiratory complications were categorized into four groups: none, mild, moderate, and severe. Interscalene blocks are important to the success of these surgeries, but there remain concerns about respiratory morbidity. *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. #interscalenebrachialplexusblock #interscaleneblock #respiratorymorbidity #respiratorycomplications #arthoplasty #shoulderarthoplasty #localanesthetic #regionalanesthesia #chronicpain #anesthesia #pain #painmanagement #MedEd #medicine

RAPM Editor-in-Chief Brian Sites, MD, joins Daniela Bravo, MD, and Julián Aliste, MD, two co-authors of “Randomized clinical trial comparing pericapsular nerve group (PENG) block and periarticular local anesthetic infiltration for total hip artholasty,” first published in February 2023. In this episode, they discuss the explosion of fascia PENG blocks in the past decade. Dr. Bravo is an assistant professor in the department of anesthesiology and perioperative medicine at the University of Chile. She is the co-director of the regional anesthesia and acute pain service. Dr. Julien Alaste is an associate professor at department of anesthesiology and perioperative medicine at the University of Chile. He is the director of the regional anesthesia and acute pain fellowship. *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. #PENGblock #arthoplasty #localanesthetic #regionalanesthesia #chronicpain #anesthesia #pain #painmanagement #MedEd #medicine

RAPM Editor-in-Chief Brian Sites, MD, joins Mercy A Udoji, MD, CMQ, FASA and Sudheer Potru, DO, FASA, FASAM, two coauthors of “Violence in the pain clinic: the hidden pandemic,” first published in August 2023 rapm-august 2023.pdf. Dr. Udoji is an associate professor of anesthesiology and pain medicine at Emory University School of Medicine. Dr. Potru is a triple-board-certified anesthesiologist, interventional pain physician, and addiction medicine specialist with strong interest in both opioid safety and addiction.

RAPM Editor-in-Chief Brian Sites, MD, joins Anjali A. Dixi, MD, the senior author of “Hospital-level variability in regional nerve block administration by race for total knee arthroplasty,” first published in December 2022 (https://rapm.bmj.com/content/early/2022/12/13/rapm-2022-104028). Dr. Dixi is from the Stanford University School of Medicine, in Stanford, CA.

The political, professional, and cultural implications of using cannabinoids remain controversial despite its increased prevalence over the last 20 years. The American Society of Regional Anesthesia and Pain Medicine established a working group in November 2020 to review the evidence and knowledge gaps around cannabis use in the perioperative period and develop clinical recommendations for the management of patients using cannabis in this setting. Authors Shalini Shah, MD, MBA, and Hance Clarke, MD, FRCPC, PhD, joined RAPM Editor-in-Chief Brian Sites, MD, to discuss committee’s findings, which were published in the article “ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids” in January 2023 (https://rapm.bmj.com/content/48/3/97). The committee used a Delphi method with > 75% consensus to answer nine clinical questions. The members concluded that all surgical patients should be screened for cannabinoid use prior to surgery, heavy users be counseled on the negative effects on postoperative pain control, and surgery be postponed for patients who present with acute cannabis intoxication. They also advised that pregnant patients be educated on the risks of maternal cannabis on the fetus/neonate. Dr. Shalini Shah is a professor and vice chair for the department of anesthesiology and director of perioperative services at the University of California at Irvine School of Medicine. She completed her residency in anesthesiology from Cornell University and a combined fellowship in adult and pediatric chronic pain at Harvard Medical School. She is the founder of the Pediatric Pain Program at UC Irvine and has previously served as associate program director for the pain medicine fellowship. Dr. Shah is the recipient of the ASRA Pain Medicine Chronic Pain Research Grant Award in 2017 for her landmark work in onabotulinumtoxinA (BOTOX®) use in pediatric migraine pain. Dr. Hance Clarke is the director of pain services and the pain research unit at the Toronto General Hospital in Toronto, Canada. He is the knowledge translation chair for the University of Toronto Centre for the Study of Pain and an associate professor in the department of anesthesiology and pain medicine at the University of Toronto. Dr. Clarke has authored more than 150 peer-reviewed publications and has been invited to speak on pain control, cannabis, and the opioid crisis to the House of Commons in Ottawa, Canada, and elsewhere around the world. *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.

The impact of the COVID-19 pandemic was especially challenging for vulnerable populations, such as those with chronic long-term health conditions, mental health conditions, and substance use disorders. Lockdowns and fear of spread led to barriers for patients whether they were accessing methadone through opioid treatment programs or being prescribed buprenorphine. A systematic review first published online in October 2022 sought to identify whether there was a change in opioid use and misuse outcomes during the COVID-19 pandemic. Authors Siddartha Simha, MD, and Mark C. Bicket, MD, PhD, joined RAPM Editor-in-Chief Brian Sites, MD, to discuss their article, “Impact of the COVID-19 pandemic on opioid overdose and other adverse events in the USA and Canada: a systematic review,” published October 2022 (https://rapm.bmj.com/content/48/1/37). The authors found that opioid-related emergency medicine use increased in most studies for both service calls and emergency department visits. Urine drug testing positivity results increased in all studies for fentanyl, and in most studies for heroin and oxycodone. Naloxone dispensation was unchanged and decreased in one study. The authors concluded that efforts to curb the spread of COVID-19 aligned with an increase in the opioid crisis severity, which has implications for future pandemic responses. Dr. Siddartha Simha is a third-year anesthesiology resident at Michigan Medicine in Ann Arbor. Originally from Troy, MI, he obtained his medical degree from Oakland University William Beaumont School of Medicine in Auburn Hills, MI. Dr. Simha has a strong interest in acute and chronic pain management and research with plans to pursue a clinical fellowship in pain medicine. Dr. Mark C. Bicket is the co-director of the Opioid Prescribing Engagement Network and an assistant professor at the University of Michigan Medical School with a joint appointment in the School of Public Health. A clinician scientist and practicing physician, his work has been supported by the National Institutes of Health, the Substance Abuse and Mental Health Services Administration, the Foundation for Anesthesia Education and Research, and the Patient-Centered Outcomes Research Institute. *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.

In November of 2021, the Regional versus General Anesthesia for Promoting Independence after Hip Fracture (REGAIN) trial was published in the New England Journal of Medicine. This study was a pragmatic randomized superiority trial to evaluate spinal anesthesia as compared with general anesthesia in 1,600 patients. The authors concluded that “spinal anesthesia for hip fracture surgery in older adults was not superior to general anesthesia with respect to survival and recovery of ambulation at 60 days.” In this month’s RAPM Focus, Editor-in-Chief Brian Sites, MD, covers both angles of this story in a daring discourse with Alexander Stone, MD, lead author of “There remains a role for neuraxial anesthesia for hip fracture surgery in the post-REGAIN era,” published March 2023 (https://rapm.bmj.com/content/early/2023/03/27/rapm-2022-104071), and Eric Schwenk, MD, lead author of “General anesthesia is an acceptable choice for hip fracture surgery,” also published March 2023 (https://rapm.bmj.com/content/early/2023/03/27/rapm-2023-104454). Dr. Alexander Stone is an anesthesiologist at Brigham and Women’s Hospital, and an assistant professor at Harvard Medical School. He completed his medical school at Johns Hopkins and his residency training at Brigham and Women’s. He went on to complete a regional anesthesia and acute pain fellowship at Hospital for Special Surgery, before returning to Brigham as a faculty member. His research interests include expanding access to regional anesthesia through enhanced recovery program implementation, as well as collaborating with other specialties. Dr. Eric Schwenk completed a fellowship in regional anesthesia and acute pain at Thomas Jefferson University Hospital in 2013 and has remained on staff as a faculty member. His research interests center on ketamine for migraine, perioperative ketamine, outcomes after orthopedic surgery, and challenging long-held dogmas in medicine. He has been an active speaker for ASRA Pain Medicine, is on the Regional Anesthesia & Pain Medicine editorial board, and is a co-author of the REGAIN study. *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.

Proponents of fascial plane blocks argue that their value can be found in opioid reduction and improvement of pain scores. On the other hand, critics argue that the effect size tends to be very small, amounting to a placebo. To address these conflicting ideas, a recent study examined the role of quadratus blocks and analgesia for laparoscopic hemicolectomy. In this month’s RAPM Focus, Editor-in-Chief Brian Sites, MD, joins Jens Borglum, MD, PhD, the senior author of “Anterior quadratus lumborum block does not reduce postoperative opioid consumption following laparoscopic hemicolectomy: a randomized, double-blind, controlled trial in an ERAS setting,” first published in September 2022 (https://rapm.bmj.com/content/48/1/7). This fascinating study had 69 patients randomized to receive either an anterior quadratus lumborum block or isotonic saline, a placebo. Dr. Jens Borglum is a consultant anesthetist, clinical research associate professor, and head of research at Zealand University Hospital, University of Copenhagen, Denmark. His main interests are ultrasound-guided nerve blocks and he is a prolific researcher and contributor to Regional Anesthesia & Pain Medicine. His clinical and research insights during the peer-review process are invaluable. *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.