RAPM Focus

This AI-generated episode of RAPM Focus discusses the May 2024 publication of “Single-bolus Injection of Local Anesthetic, With or Without Continuous Infusion, for Interscalene Brachial Plexus Block in the Setting of Multimodal Analgesia: A Randomized Controlled Unblinded Trial” by Dr. Patrick Rhyner et al.” For anyone facing shoulder surgery, pain management after the procedure is crucial. In this paper, Rhyner et al. question whether or not a continuous infusion of pain medication through a catheter is better than giving a patient a single injection after having shoulder surgery. The paper discusses a multimodal approach of pain management—dethamexazone, magnesium, acetaminophen, and ketorolac. In this study, patients undergoing two common shoulder surgeries—shoulder arthroplasty or arthroscopic rotator cuff repair—were divided into two groups, in which one group received a continuous infusion of medication via catheters, or a single dose of pain relief. Results were measured by how much morphine patients needed through a patient-controlled analgesia pump during the first 24 hours after surgery. *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, LinkedIn @ Regional Anesthesia & Pain Medicine, Facebook @Regional Anesthesia & Pain Medicine, and Instagram @RAPM_Online.

Hosted by RAPM Editor Eric Schwenk, MD, this episode of RAPM Focus welcomes RAPM Associate Editor Mark Bicket, MD, PhD, and medical student Sama Ramo following the recent publication of their original research paper, “Risk Factors for Persistent Postoperative Opioid Use: An Entity Distinct from Chronic Postsurgical Pain,” included in the February 2025 special edition of RAPM, titled “Tackling the Challenge of Chronic Postsurgical Pain.” Persistent postoperative opioid use results when patients continue to take prescription opioids well beyond the time their pain after surgery would be expected to resolve. In some cases, this is a couple days; in other cases, this is several weeks. There are many challenges associated with prescription opioid use, including the lack of a truly safe dose, so there is risk across the continuum. Patients facing persistent postoperative opioid use potentially confront worse outcomes, higher rates of health care utilization, and higher rates of mortality compared to patients not enduring persistent postoperative opioid use. Dr. Mark Bicket is an associate professor of anesthesiology with tenure at the University of Michigan and a joint appointment in the Department of Health Management and Policy at the School of Public Health. Additionally, he is co-director of the Overdose Prevention Engagement Network (OPEN). A clinician-scientist and practicing physician anesthesiologist, Dr. Bicket has pioneered evidence-based approaches to reduce opioid-related harms and improve the treatment of persons who experience pain. He currently leads an NIH R01 study examining pain-related outcomes for persons with opioid use disorder who have surgery and serves as PI for two pragmatic trials funded by the Patient-Centered Outcomes Research Institute including the CARES study, an international randomized clinical trial examining commonly prescribed treatments for postoperative pain. He previously served on the National Academy of Medicine ad hoc committee on evidence for opioid prescribing guidelines in 2018-2019 and a workshop on opioid disposal in 2023. Dr. Bicket has advised the White House, FDA, CMS, state governments, and national organizations on pain and opioid issues. His research, which includes 120 peer-reviewed articles, has appeared in JAMA, NEJM, and BMJ, and has been supported by the Foundation for Anesthesia Education and Research (FAER), SAMHSA, and CDC. Sama Ramo is a second-year medical student at Oakland University William Beaumont School of Medicine. She is a Foundation for Anesthesia Education and Research scholar. *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.

This episode of RAPM Focus introduces something new—an episode generated completely by artificial intelligence, specifically Google Notebook. As part of RAPM’s commitment to exploring innovative ways to deliver content, RAPM is trialing this approach and would love to hear your feedback. This AI-generated episode is centered around an original research paper first published in RAPM in November 2024, “Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of upper and lower limb nerve blocks.” This podcast episode highlights the power of clear communication in medicine, and the ways in which nomenclature brings order to the world of medical terminology. Specifically, the inconsistent naming of nerve blocks can lead to confusion and chaos that result in real consequences. Different doctors and researchers using different names for the same techniques leads to difficulties in comparing results and sharing knowledge. “Standardizing nomenclature in regional anesthesia: an ASRA-ESRA Delphi consensus study of upper and lower limb nerve blocks” dives into how convoluted the names of nerve blocks have become. This leads to a recipe for miscommunication—not ideal in the world of pain management. By standardizing the nomenclature of nerve blocks, patient safety is increased for those undergoing surgeries involving nerve blocks. The study lays out a clear system for naming nerve blocks in order to standardize the language of nerve blocks. This system showcases the importance of nomenclature in not just nerve blocks, but in pain management and medicine as a whole. *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 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. Find RAPM 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 thrilled to welcome Kesavan Sadacharam, MD, and Allison Fernandez, MD, following the April 2024 publication of their original research paper, “Multisite prospective study of perioperative pain management practices for anterior cruciate ligament reconstruction in adolescents: Society for Pediatric Anesthesia Improvement Network (SPAIN) Project Report.” Unwarranted variation in health care refers to differences in health care delivery that cannot be attributed to patient illness, medical evidence, or patient preferences. Instead, these variations arise from differing local medical practices, resource availability, and physician decision-making processes. Unwarranted variations can lead to sub-optimal patient outcomes, with some patients receiving unnecessary or harmful treatments while others may not receive beneficial interventions. Two individuals are behind a multi-center collaborative initiative that looks at the utilization of regional anesthesia and pain medicine techniques for ACL reconstruction. Dr. Allison Fernandez is an associate professor at Johns Hopkins All Children’s Hospital, practicing pediatric anesthesia, and pediatric acute and chronic pain management. Dr. Fernandez started a video series, Women of Impact in Anesthesia, empowering women in medicine. Dr. Kesavan Sadacharam is a pediatric anesthesiologist and associate professor at Nemours Children’s Health, located in Wilmington, DE. He is currently the director of regional anesthesia and practices both acute and chronic pain management. *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 thrilled to welcome Laura Graham, PhD, MPH, and Sesh Mudumbai, MD, MS, following the April 2024 publication of their brief technical report, “Use of natural language processing method to identify regional anesthesia from clinical notes.” One definition of medicine is the science and practice of the diagnosis treatment in prevention of disease. Science itself involves diagnoses and relies on the process of assessing data to determine cause and effect in therapies. However, in the busy world of clinical productivity and limited resources, the science of medicine is often overlooked. Physicians struggle to extract meaningful data from electronic medical records, despite their great potential. This is often due to the prioritization of funding for billing and compliance, which leads to challenges in accessing meaningful data. Additionally, barriers such as data license agreements and institutional review board considerations further complicate matters. This is why Dr. Sites is excited about new technologies, such as artificial intelligence that can assist physicians in the practice in the science of medicine. Dr. Laura Graham is an epidemiologist with VA’s Health Economics Resource Center at the VA Palo Alto Health Care System and an associate faculty with the Stanford-Surgery, Policy, Improvement Research, and Education Center at the Stanford University School of Medicine. Her research interests include causal inference methods and improving clinical processes of care for surgery.Dr. Sesh Mudumbai is an associate professor in the Department of Anesthesiology, Perioperative, and Pain Medicine at Stanford University School of Medicine and a staff anesthesiologist at the VA Palo Alto Health Care System. His research interests include using and developing informatics tools to improve opioid management and perioperative 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.